Cardiac Magnetic Resonance Imaging Versus Transthoracic Echocardiography for Prediction of Outcomes in Chronic Aortic or Mitral Regurgitation

• Published in: The American journal of cardiology Vol. 119; no. 7; pp. 1074 - 1081
• Main Authors: Harris, Andrew W., Krieger, Eric V., Kim, Minkyu, Cawley, Peter J., Owens, David S., Hamilton-Craig, Christian, Maki, Jeffrey, Otto, Catherine M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017; Elsevier Limited
• Subjects: Adult; Aged; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - therapy; Cardiology; Cardiovascular; Chronic Disease; Clinical outcomes; Colleges & universities; Echocardiography - methods; Female; Heart failure; Heart surgery; Hospitalization; Humans; Kaplan-Meier Estimate; Magnetic Resonance Imaging - methods; Male; Middle Aged; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - therapy; NMR; Nuclear magnetic resonance; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Ultrasonic imaging; Mitral Regurgitation; Cardiac Magnetic Resonance; Echocardiography; Aortic regurgitation
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.12.017

In subjects with aortic regurgitation (AR) or mitral regurgitation (MR), transthoracic echocardiography (TTE) is recommended for surveillance. Few prospective studies have directly compared the ability of TTE and cardiac magnetic resonance (CMR) to predict clinical outcomes in AR and MR. We hypothesized that, given its higher reproducibility, CMR would predict the need for valve surgery or heart failure (HF) hospitalization better than TTE. Quantitative TTE and CMR were performed on the same day for 51 subjects: 29 with chronic AR and 22 with chronic, primary MR for quantification of valve regurgitation. Baseline measurements of valve regurgitation were compared to the combined primary end point of new HF and valve surgery using receiver operating characteristics, simple logistic regression, and Kaplan–Meier survival analyses. The primary end point occurred in 5 AR subjects (all surgery) and 8 MR subjects (7 surgery, 1 HF) after a mean follow-up of 4.4 ± 1.5 years. For AR, CMR-derived regurgitant volume >50 ml identified those at high risk with 50% undergoing valve surgery versus 0% for those with regurgitant volume ≤50 ml and was more strongly associated with outcomes than regurgitant volume by TTE (p <0.05). For MR, 6.8% of those with regurgitant volume by TTE ≤30 ml developed the primary end point versus 70% in those with regurgitant volume >30 ml. Regurgitant volume by CMR showed no significant separation of survival curves for MR. In conclusion, regurgitant volume by CMR was more predictive of outcomes than by TTE in subjects with AR. In MR, the 2 methods performed similarly.