Comparison of Chronic Rheumatic Mitral Regurgitation Severity between Cardiac Magnetic Resonance Imaging and Echocardiography

Background and Purpose Traditionally, echocardiography has been used for assessing mitral regurgitation (MR) severity. However, existing qualitative, semi-quantitative and quantitative parameters suffer from several limitations. The shortcomings of the current echocardiographic methods for MR severity assessment are especially pronounced in the context of eccentric MR jets. Cardiac magnetic resonance (CMR) imaging is useful for assessing valvular lesions as it is now the gold standard for assessing left ventricular and left atrial volumes. Therefore, we sought to study and compare echocardiography with CMR for assessment of chronic rheumatic MR severity. Methods Twenty-two patients with chronic rheumatic MR who underwent both CMR and echocardiography were studied. For the echocardiography part of the study, the MR severity was assessed as per current guidelines. The CMR measurements were performed per standard guidelines by a single operator experienced in this technique. Results The mean age of the study population was 36.3±13.9 years and 81% were females. There was overall poor agreement for the assessment of MR severity using the quantitative parameters for MR assessment between echocardiography and CMR. Although the measurements for end diastolic volume index (EDVi), end systolic volume index (ESVi), regurgitant volume (RV) and regurgitant fraction (RF) showed moderate correlation, these parameters displayed poor agreement between the two tests. We noted discrepant findings in terms of classification of valve lesion severity in seven patients. Six patients were reclassified after CMR to severe MR and one to moderate MR based on quantitative parameters of regurgitant volume (RV) and regurgitant fraction (RF). Conclusion In patients with severe chronic rheumatic MR with eccentric jets, when MR quantification by echocardiography is inadequate, CMR derived quantitative volumetric parameters may be useful for accurate classification of the severity of mitral regurgitation.