title: Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial.
abstract: BACKGROUND
  The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important.
  
  
  OBJECTIVE
  The purpose of this study was to compare echocardiography and magnetic resonance imaging (MRI) in the assessment of MR severity using the degree of left ventricular (LV) remodeling after surgery as the reference standard.
  
  
  METHODS
  In this prospective multicenter trial, MR severity was assessed in 103 patients using both echocardiography and MRI. Thirty-eight patients subsequently had isolated mitral valve surgery, and 26 of these had an additional MRI performed 5 to 7 months after surgery. The pre-surgical estimate of regurgitant severity was correlated with the postoperative decrease in LV end-diastolic volume.
  
  
  RESULTS
  Agreement between MRI and echocardiographic estimates of MR severity was modest in the overall cohort (r = 0.6; p < 0.0001), and there was a poorer correlation in the subset of patients sent for surgery (r = 0.4; p = 0.01). There was a strong correlation between post-surgical LV remodeling and MR severity as assessed by MRI (r = 0.85; p < 0.0001), and no correlation between post-surgical LV remodeling and MR severity as assessed by echocardiography (r = 0.32; p = 0.1).
  
  
  CONCLUSIONS
  The data suggest that MRI is more accurate than echocardiography in assessing the severity of MR. MRI should be considered in those patients when MR severity as assessed by echocardiography is influencing important clinical decisions, such as the decision to undergo MR surgery.
authors: Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, New Jersey.
authors: Seth
authors: S
authors: Uretsky
authors: Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, New Jersey.
authors: Linda
authors: L
authors: Gillam
authors: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors: Roberto
authors: R
authors: Lang
authors: Department of Cardiovascular Medicine, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York.
authors: Farooq A
authors: FA
authors: Chaudhry
authors: Division of Cardiology, Mt. Sinai St. Luke's and Roosevelt Hospitals, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York.
authors: Edgar
authors: E
authors: Argulian
authors: Division of Cardiology, Mt. Sinai St. Luke's and Roosevelt Hospitals, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York.
authors: Azhar
authors: A
authors: Supariwala
authors: Division of Cardiology, Mt. Sinai St. Luke's and Roosevelt Hospitals, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York.
authors: Srinivasa
authors: S
authors: Gurram
authors: Division of Cardiology, Mt. Sinai St. Luke's and Roosevelt Hospitals, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York.
authors: Kavya
authors: K
authors: Jain
authors: Division of Cardiology, Mt. Sinai St. Luke's and Roosevelt Hospitals, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York.
authors: Marjorie
authors: M
authors: Subero
authors: San Jose Medical Center, Kaiser Permanente, San Jose, California.
authors: James J
authors: JJ
authors: Jang
authors: Division of Cardiology, Mt. Sinai St. Luke's and Roosevelt Hospitals, Icahn School of Medicine at Mount Sinai School of Medicine, New York, New York.
authors: Randy
authors: R
authors: Cohen
authors: Carnegie Hill Radiology, New York, New York. Electronic address: sdwolff@mrict.com.
authors: Steven D
authors: SD
authors: Wolff
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D020257:Ventricular Remodeling
keywords: mitral valve insufficiency; mitral valve surgery; observer variation; quantification; remodeling; reproducibility of results