title: Routine cine-CMR for prosthesis-associated mitral regurgitation: a multicenter comparison to echocardiography.
abstract: OBJECTIVE
  Mitral regurgitation (MR) is an important complication after prosthetic mitral valve (PMV) implantation. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with PMV. Cine-cardiac magnetic resonance (CMR) holds the potential for the non-invasive assessment of regurgitant severity based on MR-induced inter-voxel dephasing. The study aim was to evaluate routine cine-CMR for the visual assessment of PMV-associated MR.
  
  
  METHODS
  Routine cine-CMR was performed at nine sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild < 1/3, moderate 1/3-2/3, severe > 2/3). MR was graded in each long-axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PVSFR). Visual interpretation was compared to quantitative analysis in a single-center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort.
  
  
  RESULTS
  The population comprised 85 PMV patients (59% mechanical valves, 41% bioprostheses). Among the derivation cohort (n = 25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p = 0.001). Patients with severe MR had an almost three-fold increase in quantitative jet area (p = 0.002), and a two-fold increase in density (p = 0.04) than did other patients. Among the multicenter cohort, cine-CMR and TEE (Δ =. 2 ± 3 days) demonstrated moderate agreement (κ = 0.44); 64% of discordances differed by ≤ 1 grade (Δ = 1.2 ± 0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value = 100%). Patients with visually graded severe MR also had more frequent PVSFR (p < 0.001), denser jets (p < 0.001), and larger left atria (p = 0.01) on cine-CMR.
  
  
  CONCLUSIONS
  Cine-CMR is useful for the assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR assessment based on jet size provides an accurate non-invasive means of screening for TEE-evidenced severe MR.
authors: Lauren A
authors: LA
authors: Simprini
authors: Anika
authors: A
authors: Afroz
authors: Mitchell A
authors: MA
authors: Cooper
authors: Igor
authors: I
authors: Klem
authors: Christoph
authors: C
authors: Jensen
authors: Raymond J
authors: RJ
authors: Kim
authors: Monvadi B
authors: MB
authors: Srichai
authors: John F
authors: JF
authors: Heitner
authors: Michael
authors: M
authors: Sood
authors: Elizabeth
authors: E
authors: Chandy
authors: Dipan J
authors: DJ
authors: Shah
authors: Juan
authors: J
authors: Lopez-Mattei
authors: Robert W
authors: RW
authors: Biederman
authors: John D
authors: JD
authors: Grizzard
authors: Anthon
authors: A
authors: Fuisz
authors: Kambiz
authors: K
authors: Ghafourian
authors: Afshin
authors: A
authors: Farzaneh-Far
authors: Jonathan
authors: J
authors: Weinsaft
mesh_terms: D000368:Aged; D001705:Bioprosthesis / Q000009:adverse effects; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology