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Valvular Heart Disease Assessment by CMR

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Cardiovascular Magnetic Resonance Imaging

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Cardiovascular magnetic resonance (CMR) has exceptional capability of performing comprehensive evaluation of simple and complex valvular heart disease. CMR has emerged as an alternative imaging modality without ionizing radiation that is applicable in patients with valvular heart disease. An important value of CMR is its ability to provide many imaging planes, which can be tailored to individual anatomy. CMR can provide quantitative measure of valvular stenosis and regurgitation, which is comparable to echocardiography. An additional advantage of CMR for assessment of valvular heart disease is its true and reproducible measurements of ventricular volumes and function, which can guide a clinician regarding appropriate timing of surgery. Furthermore, CMR is able to evaluate great vessel anatomy and the presence of the myocardial scar, which can be of prognostic significance. Therefore, CMR is an attractive alternative or complimentary modality for thorough assessment of valvular pathology and can significantly guide the clinician and advance patient’s care.

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References

  1. Myerson SG. Heart valve disease: investigation by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Cawley PJ, Maki JH, Otto CM. Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation. 2009;119(3):468–78.

    Article  PubMed  Google Scholar 

  3. Han Y, Peters DC, Salton CJ, Bzymek D, Nezafat R, Goddu B, et al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging. 2008;1(3):294–303.

    Article  PubMed  Google Scholar 

  4. Lopez-Mattei JC, Shah DJ. The role of cardiac magnetic resonance in valvular heart disease. Methodist Debakey Cardiovasc J. 2013;9(3):142–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sommer G, Bremerich J, Lund G. Magnetic resonance imaging in valvular heart disease: clinical application and current role for patient management. J Magn Reson Imaging. 2012;35(6):1241–52.

    Article  PubMed  Google Scholar 

  6. Karamitsos TD, Myerson SG. The role of cardiovascular magnetic resonance in the evaluation of valve disease. Prog Cardiovasc Dis. 2011;54(3):276–86.

    Article  PubMed  Google Scholar 

  7. Gatehouse PD, Keegan J, Crowe LA, Masood S, Mohiaddin RH, Kreitner KF, et al. Applications of phase-contrast flow and velocity imaging in cardiovascular MRI. Eur Radiol. 2005;15(10):2172–84.

    Article  PubMed  Google Scholar 

  8. Kilner PJ, Firmin DN, Rees RS, Martinez J, Pennell DJ, Mohiaddin RH, et al. Valve and great vessel stenosis: assessment with MR jet velocity mapping. Radiology. 1991;178(1):229–35.

    Article  CAS  PubMed  Google Scholar 

  9. O’Brien KR, Gabriel RS, Greiser A, Cowan BR, Young AA, Kerr AJ. Aortic valve stenotic area calculation from phase contrast cardiovascular magnetic resonance: the importance of short echo time. J Cardiovasc Magn Reson. 2009;11:49.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148(1):e1–e132.

    Article  PubMed  Google Scholar 

  11. Bellenger NG, Burgess MI, Ray SG, Lahiri A, Coats AJ, Cleland JG, et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J. 2000;21(16):1387–96.

    Article  CAS  PubMed  Google Scholar 

  12. Myerson SG, Bellenger NG, Pennell DJ. Assessment of left ventricular mass by cardiovascular magnetic resonance. Hypertension. 2002;39(3):750–5.

    Article  CAS  PubMed  Google Scholar 

  13. Koch JA, Poll LW, Godehardt E, Korbmacher B, Modder U. Right and left ventricular volume measurements in an animal heart model in vitro: first experiences with cardiac MRI at 1.0 T. Eur Radiol. 2000;10(3):455–8.

    Article  CAS  PubMed  Google Scholar 

  14. Walsh TF, Hundley WG. Assessment of ventricular function with cardiovascular magnetic resonance. Magn Reson Imaging Clin N Am. 2007;15(4):487–504. v

    Article  PubMed  Google Scholar 

  15. Pennell DJ. Ventricular volume and mass by CMR. J Cardiovasc Magn Reson. 2002;4(4):507–13.

    Article  PubMed  Google Scholar 

  16. Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JA. LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging. 2012;5(8):837–48.

    Article  PubMed  PubMed Central  Google Scholar 

  17. John AS, Dill T, Brandt RR, Rau M, Ricken W, Bachmann G, et al. Magnetic resonance to assess the aortic valve area in aortic stenosis: how does it compare to current diagnostic standards? J Am Coll Cardiol. 2003;42(3):519–26.

    Article  PubMed  Google Scholar 

  18. Kupfahl C, Honold M, Meinhardt G, Vogelsberg H, Wagner A, Mahrholdt H, et al. Evaluation of aortic stenosis by cardiovascular magnetic resonance imaging: comparison with established routine clinical techniques. Heart. 2004;90(8):893–901.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson. 2008;10:35. https://doi.org/10.1186/1532-429X-10-35.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Caruthers SD, Lin SJ, Brown P, Watkins MP, Williams TA, Lehr KA, et al. Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography. Circulation. 2003;108(18):2236–43.

    Article  PubMed  Google Scholar 

  21. Sondergaard L, Hildebrandt P, Lindvig K, Thomsen C, Stahlberg F, Kassis E, et al. Valve area and cardiac output in aortic stenosis: quantification by magnetic resonance velocity mapping. Am Heart J. 1993;126(5):1156–64.

    Article  CAS  PubMed  Google Scholar 

  22. Pouleur AC, le Polain de Waroux JB, Pasquet A, Vancraeynest D, Vanoverschelde JL, Gerber BL. Planimetric and continuity equation assessment of aortic valve area: head to head comparison between cardiac magnetic resonance and echocardiography. J Magn Reson Imaging. 2007;26(6):1436–43.

    Article  PubMed  Google Scholar 

  23. Mohiaddin RH, Kilner PJ. Valvular heart disease. In: Manning WJ, Pennell DJ, editors. Cardiovascular magnetic resonance. Philadelphia: Churchill Livingstone; 2002. p. 387–404.

    Google Scholar 

  24. O’Brien KR, Gabriel RS, Greiser A, Cowan BR, Young AA, Kerr AJ. Aortic valve stenotic area calculation from phase contrast cardiovascular magnetic resonance: the importance of short echo time. J Cardiovasc Magn Reson. 2009;11:49.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Barone-Rochette G, Pierard S, De Meester de Ravenstein C, Seldrum S, Melchior J, Maes F, et al. Prognostic significance of LGE by CMR in aortic stenosis patients undergoing valve replacement. J Am Coll Cardiol. 2014;64(2):144–54.

    Article  PubMed  Google Scholar 

  26. Wagner S, Auffermann W, Buser P, Lim TH, Kircher B, Pflugfelder P, Higgins CB. Diagnostic accuracy and estimation of the severity of valvular regurgitation from the signal void on cine magnetic resonance images. Am Heart J. 1989;118:760–7.

    Article  CAS  PubMed  Google Scholar 

  27. Dyverfeldt P, Bissell M, Barker AJ, Bolger AF, Carlhall CJ, Ebbers T, et al. 4D flow cardiovascular magnetic resonance consensus statement. J Cardiovasc Magn Reson. 2015;17(1):72.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Keegan J, Gatehouse PD, John AS, Mohiaddin RH, Firmin DN. Breath-hold signal-loss sequence for the qualitative assessment of flow disturbances in cardiovascular MR. J Magn Reson Imaging. 2003;18(4):496–501.

    Article  PubMed  Google Scholar 

  29. Nishimura T, Yamada N, Itoh A, Miyatake K. Cine MR imaging in mitral regurgitation: comparison with color Doppler flow imaging. AJR Am J Roentgenol. 1989;153:721–4.

    Article  CAS  PubMed  Google Scholar 

  30. Myerson SG, d’Arcy J, Mohiaddin R, Greenwood JP, Karamitsos TD, Francis JM, et al. Aortic regurgitation quantification using cardiovascular magnetic resonance: association with clinical outcome. Circulation. 2012;126(12):1452–60.

    Article  PubMed  Google Scholar 

  31. Sondergaard L, Lindvig K, Hildebrandt P, Thomsen C, Stahlberg F, Joen T, et al. Quantification of aortic regurgitation by magnetic resonance velocity mapping. Am Heart J. 1993;125(4):1081–90.

    Article  CAS  PubMed  Google Scholar 

  32. Suzuki JI, Caputo GR, Kondo C, Higgins CB. Cine MR imaging of valvular heart disease: display and imaging parameters affect the size of the signal void caused by valvular regurgitation. AJR Am J Roentgenol. 1990;155:723–7.

    Article  CAS  PubMed  Google Scholar 

  33. Sechtem U, Pflugfelder PW, Cassidy MM, White RD, Cheitlin MD, et al. Mitral or aortic regurgitation: quantification of regurgitant volumes with cine MR imaging. Radiology. 1988;167(2):425–30.

    Article  CAS  PubMed  Google Scholar 

  34. Baldy C, Douek P, Croisille P, Magnin IE, Revel D, Amiel M. Automated myocardial edge detection from breath-hold cine-MR images: evaluation of left ventricular volumes and mass. Magn Reson Imaging. 1994;12(4):589–98.

    Article  CAS  PubMed  Google Scholar 

  35. Chatzimavroudis GP, Oshinski JN, Franch RH, Pettigrew RI, Walker PG, Yoganathan AP. Quantification of the aortic regurgitant volume with magnetic resonance phase velocity mapping: a clinical investigation of the importance of imaging slice location. J Heart Valve Dis. 1998;7(1):94–101.

    CAS  PubMed  Google Scholar 

  36. Djavidani B, Debl K, Lenhart M, Seitz J, Paetzel C, Schmid FX, et al. Planimetry of mitral valve stenosis by magnetic resonance imaging. J Am Coll Cardiol. 2005;45(12):2048–53.

    Article  PubMed  Google Scholar 

  37. Heidenreich PA, Steffens J, Fujita N, O’Sullivan M, Caputo GR, Foster E, et al. Evaluation of mitral stenosis with velocity-encoded cine-magnetic resonance imaging. Am J Cardiol. 1995;75(5):365–9.

    Article  CAS  PubMed  Google Scholar 

  38. Lin SJ, Brown PA, Watkins MP, Williams TA, Lehr KA, Liu W, et al. Quantification of stenotic mitral valve area with magnetic resonance imaging and comparison with Doppler ultrasound. J Am Coll Cardiol. 2004;44(1):133–7.

    Article  PubMed  Google Scholar 

  39. Ohyama H, Hosomi N, Takahashi T, Mizushige K, Osaka K, Kohno M, et al. Comparison of magnetic resonance imaging and transesophageal echocardiography in detection of thrombus in the left atrial appendage. Stroke. 2003;34(10):2436–9.

    Article  PubMed  Google Scholar 

  40. Chan KM, Wage R, Symmonds K, Rahman-Haley S, Mohiaddin RH, Firmin DN, et al. Towards comprehensive assessment of mitral regurgitation using cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2008;10:61.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Stork A, Franzen O, Ruschewski H, Detter C, Mullerleile K, Bansmann PM, et al. Assessment of functional anatomy of the mitral valve in patients with mitral regurgitation with cine magnetic resonance imaging: comparison with transesophageal echocardiography and surgical results. Eur Radiol. 2007;17(12):3189–98.

    Article  CAS  PubMed  Google Scholar 

  42. Gelfand EV, Hughes S, Hauser TH, Yeon SB, Goepfert L, Kissinger KV, et al. Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography. J Cardiovasc Magn Reson. 2006;8(3):503–7.

    Article  PubMed  Google Scholar 

  43. Benjamin J. Pomerantz, Marc D. Krock, Jason R. Wollmuth, Brian P. Cupps, Nicholas T. Kouchoukos, Victor G. Davila-Roman, Michael K. Pasque. Aortic Valve Replacement for Aortic Insufficiency: Valve Type as a Determinant of Systolic Strain Recovery. J Cardiac Surg. 2005;20(6):524–9.

    Google Scholar 

  44. Uretsky S, Gillam L, Lang R, Chaudhry FA, Argulian E, Supariwala A, et al. Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial. J Am Coll Cardiol. 2015;65(11):1078–88.

    Article  PubMed  Google Scholar 

  45. Morello A, Gelfand EV. Cardiovascular magnetic resonance imaging for valvular heart disease. Curr Heart Fail Rep. 2009;6(3):160–6.

    Article  PubMed  Google Scholar 

  46. Rebergen SA, Chin JG, Ottenkamp J, van der Wall EE, de Roos A. Pulmonary regurgitation in the late postoperative follow-up of tetralogy of Fallot. Volumetric quantitation by nuclear magnetic resonance velocity mapping. Circulation. 1993;88(5 Pt 1):2257–66.

    Article  CAS  PubMed  Google Scholar 

  47. Mercer-Rosa L, Yang W, Kutty S, Rychik J, Fogel M, Goldmuntz E. Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot: a comparative analysis of echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging. 2012;5(5):637–43.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Li W, Davlouros PA, Kilner PJ, Pennell DJ, Gibson D, Henein MY, et al. Doppler-echocardiographic assessment of pulmonary regurgitation in adults with repaired tetralogy of Fallot: comparison with cardiovascular magnetic resonance imaging. Am Heart J. 2004;147(1):165–72.

    Article  PubMed  Google Scholar 

  49. Geva T. Indications and timing of pulmonary valve replacement after tetralogy of fallot repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006:11–22.

    Article  Google Scholar 

  50. Secchi F, Resta EC, Cannao PM, Tresoldi S, Butera G, Carminati M, et al. Four-year cardiac magnetic resonance (CMR) follow-up of patients treated with percutaneous pulmonary valve stent implantation. Eur Radiol. 2015;25(12):3606–13.

    Article  PubMed  Google Scholar 

  51. Maragiannis D, Jackson MS, Flores-Arredondo JH, Autry K, Schutt RC, Alvarez PA, et al. Functional assessment of bioprosthetic aortic valves by CMR. JACC Cardiovasc Imaging. 2016 Jul;9(7):785–93.

    Article  PubMed  Google Scholar 

  52. Edwards MB, Taylor KM, Shellock FG. Prosthetic heart valves: evaluation of magnetic field interactions, heating, and artifacts at 1.5 T. J Magn Reson Imaging. 2000;12(2):363–9.

    Article  CAS  PubMed  Google Scholar 

  53. Edwards MB, Draper ER, Hand JW, Taylor KM, Young IR. Mechanical testing of human cardiac tissue: some implications for MRI safety. J Cardiovasc Magn Reson. 2005;7(5):835–40.

    Article  PubMed  Google Scholar 

  54. Hamilton-Craig C, Strugnell W, Gaikwad N, Ischenko M, Speranza V, Chan J, et al. Quantitation of mitral regurgitation after percutaneous MitraClip repair: comparison of Doppler echocardiography and cardiac magnetic resonance imaging. Ann Cardiothorac Surg. 2015;4(4):341–51.

    PubMed  PubMed Central  Google Scholar 

  55. Hartlage GR, Babaliaros VC, Thourani VH, Hayek S, Chrysohoou C, Ghasemzadeh N, et al. The role of cardiovascular magnetic resonance in stratifying paravalvular leak severity after transcatheter aortic valve replacement: an observational outcome study. J Cardiovasc Magn Reson. 2014;16:93.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Fogel MA, Pawlowski TW, Whitehead KK, Harris MA, Keller MS, Glatz AC, et al. Cardiac magnetic resonance and the need for routine cardiac catheterization in single ventricle patients prior to Fontan: a comparison of 3 groups: pre-Fontan CMR versus cath evaluation. J Am Coll Cardiol. 2012;60(12):1094–102.

    Article  PubMed  Google Scholar 

  57. Geva T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson. 2011;13:9.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Pomerantz BJ, Krock MD, Wollmuth JR, Cupps BP, Kouchoukos NT, et al. Aortic valve replacement for aortic insufficiency: valve type as a determinant of systolic strain recovery. J Card Surg. 2005;20(6):524–9.

    Article  PubMed  Google Scholar 

  59. Perez de Arenaza D, Lees B, Flather M, Nugara F, Husebye T, Jasinski M, et al. ASSERT (Aortic Stentless versus Stented valve assessed by Echocardiography Randomized Trial) investigators. Randomized comparison of stentless versus stented valves for aortic stenosis: effects on left ventricular mass. Circulation. 2005;112(17):2696–702.

    Article  PubMed  Google Scholar 

  60. Westenberg JJ, van der Geest RJ, Lamb HJ, Versteegh MI, Braun J, Doornbos J, et al. MRI to evaluate left atrial and ventricular reverse remodeling after restrictive mitral annuloplasty in dilated cardiomyopathy. Circulation. 2005;112(9 Suppl):I 437–442.

    Google Scholar 

  61. Kvitting JP, Ebbers T, Wigstrom L, Engvall J, Olin CL, Bolger AF. Flow patterns in the aortic root and the aorta studied with time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging: implications for aortic valve-sparing surgery. J Thorac Cardiovasc Surg. 2004;127(6):1602–7.

    Article  PubMed  Google Scholar 

  62. Myerson SG, Francis JM, Neubauer S. Direct and indirect quantification of mitral regurgitation with cardiovascular magnetic resonance, and the effect of heart rate variability. MAGMA. 2010;23(4):243–9.

    Article  PubMed  Google Scholar 

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Galazka, P.Z., Kwong, R.Y. (2019). Valvular Heart Disease Assessment by CMR. In: Kwong, R., Jerosch-Herold, M., Heydari, B. (eds) Cardiovascular Magnetic Resonance Imaging. Contemporary Cardiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-8841-9_18

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