Author + information
- Received November 19, 2018
- Revision received January 17, 2019
- Accepted February 1, 2019
- Published online April 17, 2019.
- Seth Uretsky, MDa,∗ (, )
- Lillian Aldaia, MDa,
- Leo Marcoff, MDa,
- Konstantinos Koulogiannis, MDa,
- Soichiro Hiramatsu, MDb,
- Edgar Argulian, MD, MPHc,
- Mark Rosenthal, MDa,
- Linda D. Gillam, MD, MPHa and
- Steven D. Wolff, MD, PhDd
- aDepartment of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey
- bDepartment of Cardiology, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
- cDivision of Cardiology, Department of Medicine, Mount Sinai St. Luke’s Hospital, Mount Sinai School of Medicine, New York, New York
- dCarnegie Hill Radiology, New York, New York
- ↵∗Address for correspondence:
Dr. Seth Uretsky, Department of Cardiovascular Medicine, Gagnon Administration, Meade B, Morristown Medical Center/Atlantic Health System, 100 Madison Avenue, Morristown, New Jersey 07960.
Objectives This study sought to assess the impact of systolic variation of mitral regurgitation (MR) has on discordance between echocardiography and magnetic resonance imaging (MRI).
Background Studies have shown discordance between echocardiography and MRI when assessing the severity of MR. Contributing factors to this discordance may include the systolic variation of MR and the use of the color Doppler jet at a single point in time as the basis of many echocardiographic methods.
Methods This analysis included 117 patients (62 ± 14 years of age; 58% male) with MR who underwent echocardiographic and MRI evaluation. Discordance was defined as the difference between the grades of MR (mild, moderate, or severe) by MRI and echocardiography. For each patient, 2 echocardiographic methods, the continuous wave time index and the color Doppler time index, and 1 MRI method, the systolic variation score (SVS), were measured to quantify systolic variation of MR.
Results There was absolute agreement between echocardiography and MRI in 47 (40%) patients, a 1-grade difference in 54 (46%) patients, and a 2-grade difference in 16 (14%) patients. Only the SVS significantly differed between patients with and without discordance (0.60 ± 0.23 vs. 0.47 ± 0.21; p = 0.003). On receiver-operating characteristic analysis SVS had moderate predictive power of discordance (area under the curve: 0.67; p = 0.003), with an SVS of 53 having a sensitivity of 61% and a specificity of 65% to predict discordance.
Conclusions Discordance between MRI and echocardiographic assessment of MR severity is associated with systolic variation of MR as quantified by MRI using the SVS. Continuous wave Doppler and the presence of color Doppler were not correlated with discordance. This study highlights an advantage of MRI. Namely, it does not rely on a single point in time to determine MR severity. Because systolic variation had only moderate sensitivity and specificity for predicting discordance, other factors are also responsible for the discordance between the 2 techniques.
Dr. Gillam is on the advisory board of Edwards Lifesciences; is an uncompensated co-principal trial investigator for Edwards Lifesciences; and oversees a hospital-based core laboratory that has contracts with Edwards Lifesciences and Medtronic. Dr. Wolff is the owner of NeoSoft. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 19, 2018.
- Revision received January 17, 2019.
- Accepted February 1, 2019.
- 2019 American College of Cardiology Foundation
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