title: Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging.
abstract: OBJECTIVE
  Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flow and cardiac chamber volume quantification. We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MIVol) related to severe MI.
  
  
  RESULTS
  In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MIVol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Aoflow). With increasing MI severity, MIVol, left heart volumes, and pulmonary venous diameters increased (P < 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MIVol >40 mL, MI regurgitant fraction >0.30, LV end-diastolic volume (LVEDV(i)) >108 mL m(-2), and a total left heart volume >188 mL m(-2) with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio >1.2. In severe MI, LV ejection fraction was unaffected, but the Aoflow and the peak ejection rate indexed to LVEDV were lowered (P < 0.05). In surgical patients, the MIVol correlated to the decrease in LV dimension after valve surgery (P < 0.02).
  
  
  CONCLUSIONS
  CMR provides a reproducible quantitative technique for evaluation of MI, as MIVol and cardiac chamber volumes can be held against diagnostic cut-off values. The Aoflow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Rigshospitalet, Copenhagen, Denmark.
authors.forename: Mark
authors.initials: M
authors.lastname: Aplin
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Rigshospitalet, Copenhagen, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Kyhl
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jenny
authors.initials: J
authors.lastname: Bjerre
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Rigshospitalet, Copenhagen, Denmark.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Ihlemann
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds University, Leed, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds University, Leed, UK.
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds University, Leed, UK.
authors.forename: Akhlaque
authors.initials: A
authors.lastname: Uddin
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Hillerød, Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Tønder
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Bispebjerg, Copenhagen, Denmark.
authors.forename: Nis Baun
authors.initials: NB
authors.lastname: Høst
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Rigshospitalet, Copenhagen, Denmark.
authors.forename: Malin Glindvad
authors.initials: MG
authors.lastname: Ahlström
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Hvidovre, Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Hove
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Rigshospitalet, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Herlev, Herlev Ringvej 75, Copenhagen, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Iversen
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Rigshospitalet, Copenhagen, Denmark.
authors.forename: Niels G
authors.initials: NG
authors.lastname: Vejlstrup
authors.affiliation: Department of Cardiology, Copenhagen University Hospitals of Herlev, Herlev Ringvej 75, Copenhagen, Denmark lav.madsen@gmail.com.
authors.forename: Per
authors.initials: P
authors.lastname: Lav Madsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark; D004452:Echocardiography / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: cardiovascular magnetic resonance imaging; mitral valve regurgitation