What is the clinical evidence from this study?

Study design: Observational. Population: Severe mitral regurgitation (n=156). Intervention: Cardiac computed tomography (CT) vs. Surgical findings. Primary outcome: Prediction of mitral valve replacement (bi-leaflet prolapse on CT) (OR 8.63, 95% CI 2.12-33.57, p=0.002).

January 1, 2019Open Access

Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement

Key Result

Preoperative cardiac CT findings of bi-leaflet prolapse (OR 8.63), leaflet thickening (OR 4.14), and leaflet calcification (OR 5.37) independently predicted the need for mitral valve replacement.

Study Design

Type

Observational (n=156)

Multicenter

Structured PICO

Does preoperative cardiac CT accurately detect mitral valve prolapse and predict the need for valve replacement in patients with severe mitral regurgitation?

Population

156 patients with severe mitral regurgitation who underwent preoperative cardiac CT and subsequent mitral valve surgery

Intervention

Preoperative cardiac computed tomography (CT)

Comparator

Surgical findings (standard reference)

Outcome

Diagnostic accuracy for the detection of mitral valve prolapse and predictability of actual valve replacementsurrogate

Preoperative cardiac CT provides high diagnostic accuracy for detecting mitral valve prolapse and predicting the need for valve replacement in patients with severe mitral regurgitation.

Main Result

Effect estimate: OR 8.63 (95% CI 2.12-33.57)

p-value: p=0.002

Limitations

Results may not be generalizable to institutions with less experienced surgeons or smaller patient volumes
Selection bias due to only including patients who underwent preoperative cardiac CT before surgery
Did not compare the diagnostic performance of transesophageal echocardiography (TEE) in all patients
Potential hazard of radiation exposure from retrospective ECG-gated CT scanning without tube current modulation

Abstract

OBJECTIVE: We aimed to investigate the diagnostic accuracy of cardiac computed tomography (CT) for the detection of mitral valve (MV) prolapse in mitral regurgitation (MR) with surgical findings as the standard reference, and to assess the predictability of MV replacement based on morphologic CT findings. MATERIALS AND METHODS: A total of 156 patients who had undergone preoperative cardiac CT and subsequently received MV surgery due to severe MR were retrospectively enrolled. Non-repairable MV was defined when at least one of the following conditions was met: 1) anterior leaflet prolapse, 2) bi-leaflet prolapse, or 3) valve morphology (leaflet thickening, calcification, or mitral annular calcification MAC). Diagnostic performance of CT for the detection of the prolapsed segment was assessed with surgical findings as the standard reference. Logistic regression analysis was performed to evaluate the value of CT findings to predict actual valve replacement. RESULTS: < 0.05). CONCLUSION: Cardiac CT can have high diagnostic performance for detecting the prolapsed segment of the MV and predictability of valve replacement before surgery. Bi-leaflet prolapse and valve morphology, such as leaflet thickening, or calcification or MAC, are the most important predictors of valve replacement.

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