title: Determination of Clinical Outcome in Mitral Regurgitation With Cardiovascular Magnetic Resonance Quantification.
abstract: Surgery for severe mitral regurgitation is indicated if symptoms or left ventricular dilation or dysfunction occur. However, prognosis is already reduced by this stage, and earlier surgery on asymptomatic patients has been advocated if valve repair is likely, but identifying suitable patients for early surgery is difficult. Quantifying the regurgitation may help, but evidence for its link with outcome is limited. Cardiovascular magnetic resonance (CMR) can accurately quantify mitral regurgitation, and we examined whether this was associated with the future need for surgery.
  
  
  
  One hundred nine asymptomatic patients with echocardiographic moderate or severe mitral regurgitation had baseline CMR scans and were followed up for up to 8 years (mean, 2.5±1.9 years). CMR quantification accurately identified patients who progressed to symptoms or other indications for surgery: 91% of subjects with regurgitant volume ≤55 mL survived to 5 years without surgery compared with only 21% with regurgitant volume >55 mL (P<0.0001). A similar separation was observed for regurgitant fraction ≤40% and >40%. CMR-derived end-diastolic volume index showed a weaker association with outcome (proportions surviving without surgery at 5 years, 90% for left ventricular end-diastolic volume index <100 mL/m(2) versus 48% for ≥100 mL/m(2)) and added little to the discriminatory power of regurgitant fraction/volume alone.
  
  
  
  CMR quantification of mitral regurgitation was associated with the development of symptoms or other indications for surgery and showed better discriminatory ability than the reference-standard CMR-derived ventricular volumes. CMR may be able to identify appropriate patients for early surgery, with the potential to change clinical practice, although the clinical benefits of early surgery require confirmation in a clinical trial.
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.). saul.myerson@cardiov.ox.ac.uk.
authors.forename: Saul G
authors.initials: SG
authors.lastname: Myerson
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: Joanna
authors.initials: J
authors.lastname: d'Arcy
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Christiansen
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dobson
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: Raad
authors.initials: R
authors.lastname: Mohiaddin
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: Jane M
authors.initials: JM
authors.lastname: Francis
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: Bernard
authors.initials: B
authors.lastname: Prendergast
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: Theodoros D
authors.initials: TD
authors.lastname: Karamitsos
authors.affiliation: From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d'A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and Lung Institute, London, UK (R.M.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures; D018450:Disease Progression; D018572:Disease-Free Survival; D004452:Echocardiography; D004739:England; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D009520:New Zealand; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D013997:Time Factors
keywords: magnetic resonance imaging; mitral valve; mitral valve insufficiency; outcome assessment (health care); prognosis