Published Online
on July 30, 2008

A more recent version of this article appeared on September 1, 2008

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Original Article

Cardiovascular Magnetic Resonance for Direct Assessment of Anatomic Regurgitant Orifice in Mitral Regurgitation

Stefan Buchner^1,3; Kurt Debl¹; Florian Poschenrieder²; Stefan Feuerbach²; Günter Riegger¹; Andreas Luchner¹ and Behrus Djavidani²

¹ Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg;
² Institut für Röntgendiagnostik, Klinikum der Universität Regensburg

³ E-mail: stefan.buchner{at}klinik.uni-regensburg.de

Background—In patients with mitral regurgitation (MR), assessment of the severity of valvular dysfunction is crucial. Recently, regurgitant orifice area has been proposed as most useful indicator of the severity of MR. The purpose of our study was to determine whether planimetry of the anatomic regurgitant orifice (ARO) in patients with MR is feasible by cardiovascular magnetic resonance (CMR) and correlates with invasive catheterization (CATH) and echocardiography (ECHO-ERO, PISA method).

Methods and Results—Planimetry of ARO was performed with a 1.5T CMR scanner using a breath-hold balanced gradient echo sequence (TrueFISP). CMR-Planimetry of ARO was possible in 35/38 patients and was closely correlated with angiographic grading (r=0.84, p<0.0001). In patients with MRIII upon CATH, CMR-ARO (0.60±0.29cm² vs. 0.30±0.19cm², p<0.0001) as well as ECHO-ERO (0.49±0.17cm² vs. 0.27±0.10cm² were significantly elevated in comparison to MR<III. Further, CMR-ARO was closely correlated to CMR-regurgitant fraction and volume (r=0.90 and r=0.91, p<0.0001, respectively) and CATH-regurgitant fraction and volume (r=0.86 and 0.83, p<0.0001, respectively). The correlation between CMR-ARO and ECHO-ERO was 0.81 (p<0.0001) and slightly overestimated ECHO-ERO by 0.06cm² (p<0.05). As assessed by ROC analysis, CMR-ARO at a threshold of 0.40cm² detected MRIII as defined by catheterization with a sensitivity and specificity of 94% and 94%, respectively.

Conclusion—CMR planimetry of the anatomic mitral regurgitant lesion in patients with MR is feasible and permits quantification of MR with good agreement with the accepted invasive and non-invasive methods. Direct measurement by CMR is a promising new method for the precise assessment of anatomic regurgitant orifice area and the severity of MR.

Key Words: catheterization • echocardiography • magnetic resonance imaging • mitral valve • regurgitation

Author contributions: Stefan Buchner, Kurt Debl, and Behrus Djavidani contributed equally to this study.