CMR regurgitant fraction reproducibility was excellent (CCC 0.95, 0.86-0.98 BA mean difference −2.4%, −11.9 to 7.0), with a lower mean difference and narrower limits of agreement compared to echocardiography. Echocardiographic Doppler regurgitant fraction reproducibility was modest (CCC 0.59, 0.15-0.84 BA mean difference −3.7%, −38% to 31%). Inter-observer reproducibility of echocardiographic visual categorical grading by expert readers was poor, with a CCC of 0.475 (−0.7, 0.74). Results: Mean age was 79 years, and mean LVEF was 44%☑1% by CMR and 54%☑6% by echocardiography. Inter-rater comparison was made by concordance correlation coefficient (CCC) with 95% confidence intervals (CIs), and Bland-Altman (BA) methods. CMR and echocardiographic data were independently and blindly analyzed by expert readers. Same-day echocardiography was performed with two-dimensional (2D) visualization and Doppler.
#Mitral regurgitation grade 1 2 3 4 free
Nine were excluded due to non-magnetic resonance imaging (MRI) compatible implants or arrhythmia, leaving 16 who underwent a comprehensive CMR examination at 1.5 T (Siemens Aera) with multiplanar steady state free precession (SSFP) cine imaging (cine CMR), and phase-contrast flow acquisitions (flow CMR) at the mitral annulus atrial to the MitraClip, and the proximal aorta. Methods: Twenty-five patients underwent successful MitraClip insertion. The objective of this study was to establish the feasibility and reproducibility of CMR in quantitating residual MR after MitraClip insertion in a prospective study. CMR phase-contrast flow imaging has superior reproducibility for quantitation of MR compared to echocardiography. Cardiovascular magnetic resonance (CMR) is the reference standard for left and right ventricular volumetric assessment. Quantitative assessment of residual MR by transthoracic echocardiography (TTE) is challenging, with multiple eccentric jets and artifact from the clips. All rights reserved.Objective: Percutaneous valve intervention for severe mitral regurgitation (MR) using the MitraClip is a novel technology. This review summarizes the prevalence and prognostic importance of atrial functional MR, providing mechanistic insights compared with those of secondary MR and suggesting potential therapeutic targets.Ītrial fibrillation functional mitral regurgitation heart failure with preserved ejection fraction mitral annular dilatation mitral annulus secondary mitral regurgitation.Ĭopyright © 2019 American College of Cardiology Foundation. Although both AF and HFpEF-two closely related disease epidemics of the 21st century-are held responsible, current guidelines do not emphasize the need to differentiate atrial functional MR from (ventricular) secondary MR.
Because of this peculiar pathophysiology, atrial functional MR benefits from a different approach compared with secondary MR. Moreover, the role of left atrial and annular dynamics in provoking MR is often underappreciated. LV size and systolic function are typically normal, whereas isolated mitral annular dilation and inadequate leaflet adaptation are considered mechanistic culprits.
Unlike secondary mitral regurgitation (MR) in the setting of left ventricular (LV) disease, the occurrence of functional MR in atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF) has remained largely unspoken.
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