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Routine cine-CMR for assessment of prosthesis-associated mitral regurgitation - a multicenter, multivendor study


Mitral regurgitation (MR) is clinically important for patients with prosthetic mitral valves (PMV). While CMR can quantify MR based on flow, this requires dedicated imaging. Cine-CMR (SSFP) provides an alternative approach, whereby MR can be graded based on regurgitation-associated intervoxel dephasing. As cine-CMR is a standard component of nearly all exams, it could be used to screen for patients who warrant further quantitative imaging. Diagnostic performance of cine-CMR for prosthesis-associated MR has not been evaluated.


Databases at 6 sites were queried for all patients with PMV in whom CMR and echocardiography were performed within 10 days. Cine-CMR images were retrieved and interpreted using a uniform protocol: MR was visually graded based solely on jet size (mild <1/3, moderate 1/3-2/3, severe >2/3) in relation to the left atrium. MR was graded in each long axis plane (2-, 3-, 4-chamber), with overall severity based on mean grade. Additional parameters included jet directionality, signal intensity (3-grade scale), and pulmonary vein flow reversal. Echocardiography (TTE, TEE) was used as a comparator for MR based on clinically reported data. Cine-CMR was interpreted blinded to patient history and TTE/TEE.


56 patients with PMV (70% mechanical, 30% bio) underwent cine-CMR and echo (TTE 70%, TEE 48%) within 2.5±2.6 days. Cine-CMR (1.5T, typical TR=3msec, TE=1msec, BW=977Hz/pixel) was performed using commercial scanners (Siemens 59%/GE 36%/Philips 5%). MR was present on cine-CMR in 77% of patients (mild 43%, moderate 14%, severe 20%), and varied in direction (central 88%, eccentric 12%). Patients with severe MR had higher prevalence of dense regurgitant jets (73% vs. 3%, p<0.001), more frequent pulmonary vein reversal (55% vs. 3%, p<0.001), and larger left atria (5.7±1.0cm vs. 4.7±1.4cm, p=0.03) than did those with lesser MR, but did not differ based on LVEF (53±14% vs. 49±15%, p=0.4). Compared to TEE, cine-CMR yielded excellent diagnostic accuracy (96%) for severe MR (Table); accuracy was also high (93%) when a broader TEE threshold (≥moderate MR) was applied. Among patients with TTE and cine-CMR, no patients had severe MR on TTE missed by cine-CMR, whereas TTE was discordant (lesser MR) in 83% (5/6) with severe MR on cine-CMR. Among those with all three tests (n=10), TEE-evidenced severe MR was diagnosed by TTE in 50% (1/2), whereas cine-CMR diagnosed severe MR in all (2/2) cases.

Table 1 Cine-CMR diagnostic performance for prosthesis-associated mitral regurgitation


Among a blinded multicenter cohort with PMV, cine-CMR yielded excellent diagnostic performance (accuracy=96%) for TEE-evidenced severe MR. Findings support use of cine-CMR for non-invasive assessment of prosthesis-associated MR.


K23 HL 102249-01.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Simprini, L.A., Afroz, A., Klem, I. et al. Routine cine-CMR for assessment of prosthesis-associated mitral regurgitation - a multicenter, multivendor study. J Cardiovasc Magn Reson 15 (Suppl 1), E100 (2013).

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