In the Journals

Cardiac MRI appropriate for assessing mitral regurgitation

Seth Uretsky

Cardiac MRI has accurately and reproducibly quantified mitral regurgitation and may be of help in predicting clinical outcomes, according to a review published in the Journal of the American College of Cardiology.

“We felt that there is a building literature supporting the use of MRI in patients with mitral regurgitation and there wasn’t a source that reviewed how best to do it and also reviewed the existing literature,” Seth Uretsky, MD, FACC, medical director of cardiovascular imaging and associate director of the Cardiovascular Fellowship Program at Atlantic Health System, said in an interview.

Although echocardiography is the most common modality used for assessing the severity of mitral regurgitation, “we believe that there is a growing literature that points to MRI as perhaps being a better way to assess mitral regurgitation,” Uretsky told Cardiology Today. “MRI can be used to quantify mitral regurgitation using imaging sequences that have been tried and true for over a decade.”

Uretsky and colleagues wrote that cardiac MRI “accurately quantifies mitral regurgitation as the difference between left ventricular stroke volume and forward stroke volume using steady-state free precession and phase contrast imaging.”

Other advantages of cardiac MRI are that it can reproducibly measure mitral regurgitant volume and can quantify mitral regurgitation without need to consider regurgitant jet morphology, the authors wrote.

Cardiac MRI can also quantify mitral regurgitant volume without using contrast in patients with multiple valve lesions or intracardiac shunts, according to the authors.

The literature supports cardiac MRI as an accurate and reproducible way to quantify mitral regurgitation and some studies have linked cardiac MRI results to clinical outcomes, they wrote.

In the review, Uretsky and colleagues devised a proposed clinical pathway and rationale for use of cardiac MRI to assess severe mitral regurgitation. If severe mitral regurgitation has been diagnosed on echocardiography, MRI without contrast should be performed to quantify regurgitant volume. If severe mitral regurgitation is confirmed by MRI, the patient should be considered for mitral valve surgery and closely monitored. If severe mitral regurgitation is not confirmed, routine follow-up should be conducted.

“There is much research that needs to be done,” Uretsky told Cardiology Today. “Most importantly, there is no randomized controlled trial that shows the severity of mitral regurgitation by either echocardiography or MRI determines who will benefit from mitral valve surgery.” – by Erik Swain

For more information:

Seth Uretsky, MD, can be reached at Department of Cardiovascular Medicine, Morristown Medical Center, 100 Madison Ave., Gagnon Administration, Meade B, Morristown, NJ 07960; email: seth.uretsky@atlantichealth.org.

Disclosures: Uretsky reports no relevant financial disclosures. Another author reports he is a member of NeoCoil LLC and NeoSoft LLC.

Seth Uretsky

Cardiac MRI has accurately and reproducibly quantified mitral regurgitation and may be of help in predicting clinical outcomes, according to a review published in the Journal of the American College of Cardiology.

“We felt that there is a building literature supporting the use of MRI in patients with mitral regurgitation and there wasn’t a source that reviewed how best to do it and also reviewed the existing literature,” Seth Uretsky, MD, FACC, medical director of cardiovascular imaging and associate director of the Cardiovascular Fellowship Program at Atlantic Health System, said in an interview.

Although echocardiography is the most common modality used for assessing the severity of mitral regurgitation, “we believe that there is a growing literature that points to MRI as perhaps being a better way to assess mitral regurgitation,” Uretsky told Cardiology Today. “MRI can be used to quantify mitral regurgitation using imaging sequences that have been tried and true for over a decade.”

Uretsky and colleagues wrote that cardiac MRI “accurately quantifies mitral regurgitation as the difference between left ventricular stroke volume and forward stroke volume using steady-state free precession and phase contrast imaging.”

Other advantages of cardiac MRI are that it can reproducibly measure mitral regurgitant volume and can quantify mitral regurgitation without need to consider regurgitant jet morphology, the authors wrote.

Cardiac MRI can also quantify mitral regurgitant volume without using contrast in patients with multiple valve lesions or intracardiac shunts, according to the authors.

The literature supports cardiac MRI as an accurate and reproducible way to quantify mitral regurgitation and some studies have linked cardiac MRI results to clinical outcomes, they wrote.

In the review, Uretsky and colleagues devised a proposed clinical pathway and rationale for use of cardiac MRI to assess severe mitral regurgitation. If severe mitral regurgitation has been diagnosed on echocardiography, MRI without contrast should be performed to quantify regurgitant volume. If severe mitral regurgitation is confirmed by MRI, the patient should be considered for mitral valve surgery and closely monitored. If severe mitral regurgitation is not confirmed, routine follow-up should be conducted.

“There is much research that needs to be done,” Uretsky told Cardiology Today. “Most importantly, there is no randomized controlled trial that shows the severity of mitral regurgitation by either echocardiography or MRI determines who will benefit from mitral valve surgery.” – by Erik Swain

For more information:

Seth Uretsky, MD, can be reached at Department of Cardiovascular Medicine, Morristown Medical Center, 100 Madison Ave., Gagnon Administration, Meade B, Morristown, NJ 07960; email: seth.uretsky@atlantichealth.org.

Disclosures: Uretsky reports no relevant financial disclosures. Another author reports he is a member of NeoCoil LLC and NeoSoft LLC.