Flow Assessment Through Four Heart Valves Simultaneously Using 3-Dimensional 3-Directional Velocity-Encoded Magnetic Resonance Imaging With Retrospective Valve Tracking in Healthy Volunteers and Patients With Valvular Regurgitation

OBJECTIVES: To validate 3-dimensional (3D) 3-directional velocity-encoded (VE) magnetic resonance imaging (MRI) for flow assessment through all 4 heart valves simultaneously with retrospective valve-tracking during off-line analysis in healthy volunteers and in patients with valvular regurgitation. MATERIAL AND METHODS: Three-dimensional 3-directional VE MRI was performed in 22 healthy volunteers and in 29 patients with ischemic cardiomyopathy who were suspected of valvular regurgitation and net flow volumes through the 4 heart valves were compared. Furthermore, the analysis was repeated for each valve in 10 healthy volunteers and in 10 regurgitant valves to assess intra- and interobserver agreement for assessment of respectively net flow volumes and regurgitation fraction. RESULTS: In healthy volunteers, the average net flow volume through the mitral valve, tricuspid valve, aortic valve, and pulmonary valve was 85 +/- 20 mL, 85 +/- 21 mL, 83 +/- 19 mL, 82 +/- 21 mL, respectively. Strong correlations between net flow volumes through the 4 heart valves were observed (intraclass correlation coefficients ICC 0.93-0.95) and the coefficient of variance (CV) was small (6%-9%). The repeated analysis by the same observer and by a second observer yielded good agreement for measurement of net flow volumes (ICC: 0.93-0.99 and CV: 3%-7%). Strong correlations between the net flow volumes through the 4 heart valves were also observed in the patients with valvular regurgitation (ICC: 0.85-0.95 and CV: 7%-18%). The average net flow volume through the mitral valve, tricuspid valve, aortic valve, and pulmonary valve was 63 +/- 20 mL, 63 +/- 20 mL, 63 +/- 20 mL, 63 +/- 20 mL, respectively. Furthermore, the intra- and interobserver agreement for assessment of regurgitation fraction was good (ICC: 0.86 and 0.85, CV: 12% and 13%). CONCLUSIONS: Flow assessment using 3D 3-directional VE MR with retrospective valve-tracking during off-line analysis enables accurate quantification of net flow volumes through 4 heart valves within a single acquisition in healthy volunteers and in patients with valvular regurgitation.