Assessment of left ventricular volumes and primary mitral regurgitation severity by 2D echocardiography and cardiovascular magnetic resonance
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Key result
In patients with moderate to severe primary mitral regurgitation, 2D transthoracic echocardiography significantly underestimated left ventricular end-diastolic volume compared to cardiovascular magnetic resonance (136 vs 164 ml, p=0.0003).
Why the study?
Does 2D transthoracic echocardiography accurately assess left ventricular volumes and mitral regurgitation severity compared to cardiovascular magnetic resonance in patients with moderate to severe primary mitral regurgitation?
Population
38 patients with at least moderate primary mitral regurgitation, left ventricular ejection fraction ≥60%…
Comparison
Two-dimensional transthoracic echocardiography vs Cardiovascular magnetic resonance (CMR)
Design
Cross-sectional, CMR data were assessed by agreement of 2 readers who were…
Authors
Discussion
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Implication
2DTTE underestimates LV remodelling versus CMR in primary MR; leaves open whether CMR refines surgical timing decisions.
Key Points
- To compare routine evaluation of left ventricular volumes and mitral regurgitation severity by two-dimensional transthoracic echocardiography against cardiovascular magnetic resonance.
- Prospectively evaluated N=38 patients (79% male, age 57 ± 14 years) with moderate-to-severe primary mitral regurgitation, left ventricular ejection fraction ≥60%, and left ventricular end-systolic diameter ≤45 mm.
- Excluded patients with coronary artery disease, arrhythmias, or significant concomitant valvular disease, scheduling all participants for both 2DTTE and CMR imaging.
- Left ventricular end-diastolic and end-systolic volumes were significantly underestimated by 2DTTE compared to CMR, despite strong correlations (Pearson r = 0.81, p < 0.00001 and r = 0.70, p < 0.00001, respectively).
- Regurgitant orifice area measurements showed no significant difference between 2DTTE PISA and CMR planimetry (47 ± 24 vs. 42 ± 16 mm², p = 0.12; Pearson r = 0.76, p < 0.0001), whereas regurgitant volume comparisons showed poor agreement.
Study Design
Type
Cross-Sectional (n=38)
Blinding
Single-blind
Multicenter
Yes
Structured PICO
Does 2D transthoracic echocardiography accurately assess left ventricular volumes and mitral regurgitation severity compared to cardiovascular magnetic resonance in patients with moderate to severe primary mitral regurgitation?
P
Population
38 patients (mean age 57 years, 21% female) with moderate to severe primary mitral regurgitation and preserved left ventricular function who underwent both 2D echocardiography and cardiovascular magnetic resonance.
E
Exposure
Two-dimensional transthoracic echocardiography (2DTTE)
C
Comparator
Cardiovascular magnetic resonance (CMR)
O
Outcome
Comparison of left ventricular volumes (end-diastolic and end-systolic) and mitral regurgitation severity (regurgitant orifice and regurgitant volume) between 2DTTE and CMR.surrogate
Main Result
Mean Difference: 28 (95% CI -53–109)
Absolute Event Rate: 136% vs 164%
p-value: p=0.0003
In patients with moderate to severe primary mitral regurgitation without overt LV dysfunction, 2DTTE significantly underestimates LV volumes compared to CMR, suggesting CMR may be valuable for determining optimal timing for surgery.
Limitations
- Did not perform more advanced echocardiographic techniques like 3D or contrast enhanced echocardiography
- No comparison with invasive measurements of LV function or MR severity by angiography
- In most patients 2DTTE and CMR were not performed on the same date, though they were done within 1 month
- Narrow range of LVEF (60-75%) due to inclusion criteria
- 2DTTE and CMR were not performed on the exact same date in most patients (within 1 month)
Cite This Study
Heyning et al. (2013) conducted a cross-sectional in Moderate to severe primary mitral regurgitation (n=38). 2D transthoracic echocardiography vs. Cardiovascular magnetic resonance was evaluated on Left ventricular end-diastolic volume (LVEDV) (average bias +28 ml, 95% CI -53 to +109, p=0.0003). In patients with moderate to severe primary mitral regurgitation, 2D transthoracic echocardiography significantly underestimated left ventricular end-diastolic volume compared to cardiovascular magnetic resonance (136 vs 164 ml, p=0.0003).
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