Key result
CMR measures ~23 mL/m2 higher mean LAVI than echocardiography in mitral regurgitation.
Why the study?
Guidelines use LAVI thresholds to guide mitral valve repair, but literature comparing echocardiography and CMR for assessing LAVI in mitral regurgitation remains scarce.
Does cardiac magnetic resonance imaging alter left atrial volume index quantification and clinical risk stratification compared to echocardiography in patients with mitral regurgitation?
Observational (n=168)
No
Does cardiac magnetic resonance imaging alter left atrial volume index quantification and clinical risk stratification compared to echocardiography in patients with mitral regurgitation?
Absolute Event Rate: 70% vs 47.1%
p-value: p=<0.001
Echocardiography systematically underestimates left atrial volume index compared to CMR by approximately 20 mL/m2, emphasizing the need for modality-specific cut-offs to accurately guide the timing of mitral valve surgery.
Echocardiography-derived LAVI may misclassify mitral regurgitation patients; leaves open whether CMR should guide surgical timing.
Background Left atrial volume index (LAVI) serves as a crucial marker for assessing left atrial (LA) remodeling, particularly in patients with mitral valve regurgitation (MR). Recent guidelines recommend a LAVI exceeding 60 mL/m 2 as Class IIa recommendation for mitral valve repair surgery in asymptomatic MR patients with preserved left ventricular function. Traditionally, echocardiography is the standard for assessing LAVI in MR patients. However, cardiac magnetic resonance imaging (CMR) is increasingly recognized for its more precise measurements of cardiac dimensions and volumes. But still, literature remains scarce on comparing the efficacy of both modalities in assessing LAVI measurements. Methods This retrospective study included 168 MR patients undergoing both echocardiography and CMR assessments within a six-month period. LAVI measurements were compared using Pearson correlation and Bland-Altman plots. Patients were stratified based on MR grades, and clinical implications were assessed. Results Mean LAVI differed significantly between echocardiography and CMR (47.1 ± 20.8 mL/m 2 versus 70 ± 20.3 mL/m 2 , p < 0.001, respectively). CMR consistently yielded higher LAVI measurements compared to echocardiography, with a mean difference of approximately 20 mL/m 2 . CMR measurements resulted in an increased incidence of patients meeting the class IIa LAVI criterion (LAVI >60 mL/m 2 ) by 37%. Variations in LAVI did not differ across MR grades. Conclusion Echocardiography systematically underestimates LAVI compared to CMR in MR patients. While current guidelines rely on echocardiography, CMR's precision suggests the need for CMR-specific LAVI cutoff values to guide clinical management effectively. Establishing such values could refine patient stratification and timing of surgery, potentially improving clinical outcomes for MR patients.
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Mathari et al. (2024) conducted an observational in Mitral valve regurgitation (n=168). Cardiac magnetic resonance imaging (CMR) vs. Echocardiography was evaluated on Mean left atrial volume index (LAVI) (p=<0.001). Cardiac magnetic resonance imaging systematically measured a significantly higher mean LAVI compared to echocardiography (70 vs 47.1 mL/m2, p<0.001) in patients with mitral valve regurgitation.
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