Key result
Including prolapsed volume in cardiac MRI analysis of mitral valve prolapse yielded a lower LVEF but more accurately reflected regurgitant volume.
Why the study?
The impact of prolapsed volume on regurgitant volume, regurgitant fraction, and left ventricular ejection fraction in patients with mitral valve prolapse using cardiac MRI remained to be determined.
Does the inclusion of prolapsed volume in cardiac MRI affect the quantification of mitral regurgitation and ejection fraction in patients with mitral valve prolapse?
Observational (n=19)
Does the inclusion of prolapsed volume in cardiac MRI affect the quantification of mitral regurgitation and ejection fraction in patients with mitral valve prolapse?
Answers are grounded in this paper and cite their sources.
Including prolapsed volume in cardiac MRI measurements for patients with mitral valve prolapse provides a more accurate assessment of mitral regurgitation severity but results in a lower calculated left ventricular ejection fraction.
Purpose To determine the impact of prolapsed volume on regurgitant volume (RegV), regurgitant fraction (RF), and left ventricular ejection fraction (LVEF) in patients with mitral valve prolapse (MVP) using cardiac MRI. Materials and Methods Patients with MVP and mitral regurgitation who underwent cardiac MRI from 2005 to 2020 were identified retrospectively from the electronic record. RegV is the difference between left ventricular stroke volume (LVSV) and aortic flow. Left ventricular end-systolic volume (LVESV) and LVSV were obtained from volumetric cine images, with prolapsed volume inclusion (LVESVp, LVSVp) and exclusion (LVESVa, LVSVa) providing two estimates of RegV (RegVp, RegVa), RF (RFp, RFa), and LVEF (LVEFa, LVEFp). Interobserver agreement for LVESVp was assessed using intraclass correlation coefficient (ICC). RegV was also calculated independently using measurements from mitral inflow and aortic net flow phase-contrast imaging as the reference standard (RegVg). Results The study included 19 patients (mean age, 28 years ± 16 [SD]; 10 male patients). Interobserver agreement for LVESVp was high (ICC, 0.98; 95% CI: 0.96, 0.99). Prolapsed volume inclusion resulted in higher LVESV (LVESVp: 95.4 mL ± 34.7 vs LVESVa: 82.4 mL ± 33.8; P < .001), lower LVSV (LVSVp: 100.5 mL ± 33.8 vs LVSVa: 113.5 mL ± 35.9; P < .001), and lower LVEF (LVEFp: 51.7% ± 5.7 vs LVEFa: 58.6% ± 6.3; P < .001). RegV was larger in magnitude when prolapsed volume was excluded (RegVa: 39.4 mL ± 21.0 vs RegVg: 25.8 mL ± 22.8; P = .02), with no evidence of a difference when including prolapsed volume (RegVp: 26.4 mL ± 16.4 vs RegVg: 25.8 mL ± 22.8; P > .99). Conclusion Measurements that included prolapsed volume most closely reflected mitral regurgitation severity, but inclusion of this volume resulted in a lower LVEF.
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Otemuyiwa et al. (2023) conducted an observational in Mitral valve prolapse and mitral regurgitation (n=19). Prolapsed volume inclusion in cardiac MRI vs. Prolapsed volume exclusion was evaluated on Left ventricular ejection fraction (LVEF) (p=<.001). Including prolapsed volume in cardiac MRI analysis of mitral valve prolapse yielded a lower LVEF but more accurately reflected regurgitant volume.
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