Key result
CMR accurately measures AR but systematically overestimates MR by ~9 ml in patients without valve disease.
Why the study?
An assessment of currently available CMR methods to quantify aortic and mitral regurgitation in a large, population-based setting was lacking.
Does cardiovascular magnetic resonance accurately quantify aortic and mitral regurgitation volumes compared to echocardiography in participants without valvular heart disease?
Cohort (n=1,874)
No
Does cardiovascular magnetic resonance accurately quantify aortic and mitral regurgitation volumes compared to echocardiography in participants without valvular heart disease?
CMR accurately measures aortic regurgitation volume, but systematically overestimates mitral regurgitation volume in individuals without valvular heart disease, suggesting cautious interpretation of CMR-derived MRV.
Supports cautious interpretation of CMR mitral regurgitation volumes; leaves open validation in valvular heart disease.
An assessment of currently available cardiovascular magnetic resonance (CMR) methods to quantify aortic (AR) and mitral regurgitation (MR) in a large, population-based setting is lacking. The aim of this study was to evaluate CMR-based AR and MR quantification methods by quantifying AR and MR in participants without valvular heart disease in the population-based Hamburg City Health Study (HCHS). CMR was performed at 3T in the HCHS population. Aortic valve regurgitation volume (CMR-ARV) was directly obtained from 2D transaortic flow measurements. Mitral valve regurgitation volumes (CMR-MRV) were calculated by subtracting aortic forward flow volumes by Flow CMR from left ventricular stroke volumes by Cine CMR as currently recommended and by a method to account for potential confounding effects of AR on MR calculations (CMR-MRV MOD ). Absence of AR and MR were assessed by echocardiography as reference technique. The final CMR study population consisted of 1,874 participants (1,261 without any AR, 1,028 without any MR). Median age of the final study population was 66.0 [58.0, 71.0] years, and 41.1% ( n = 770) of participants were female. Median CMR-ARV was 0.7 [0.2, 1.7] ml in participants without any AR. Median CMR-MRV was 9.4 [4.0, 17.0] ml and median CMR-MRV MOD was 8.7 [4.0, 15.2] ml in participants without any MR, as defined by echocardiography. Unlike accurate, direct ARV measurements by Flow CMR, the currently recommended CMR approach for MRV quantification seems to be affected by a systematic error. MRV measurements by CMR require cautious interpretation, taking into account site specific features.
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Riedl et al. (2025) conducted a cohort in Without valvular heart disease (n=1,874). Cardiovascular magnetic resonance (CMR) vs. Echocardiography was evaluated on Median mitral valve regurgitation volume (CMR-MRV) in participants without any MR by echocardiography. Cardiovascular magnetic resonance accurately measured aortic regurgitation volume (median 0.7 ml) but systematically overestimated mitral regurgitation volume (median 9.4 ml) in participants without valvular heart disease.
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