Cardiac Magnetic Resonance Imaging for Mitral Regurgitation

INTRODUCTION

Over the last several decades, cardiac magnetic resonance (CMR) has emerged as an invaluable tool in cardiovascular imaging. CMR is a comprehensive noninvasive imaging modality that offers high spatial and temporal resolution without ionizing radiation. Images can be acquired in any imaging plane without limitation by body habitus, chest wall anatomy, or lung interference. CMR is considered the gold standard for noninvasive assessment of left ventricular volumes and ejection fraction with high accuracy and reproducibility. Functional cardiac assessment can be obtained without contrast. Myocardial tissue characteristics such as myocardial infarction, fibrosis, or infiltration can be assessed using gadolinium-based contrast.

MITRAL REGURGITATION

CMR is particularly useful in the evaluation of mitral regurgitation with the ability to accurately quantify severity of regurgitation, further delineate pathophysiology and mechanism of mitral regurgitation, and assess hemodynamic effects of volume overload as the gold standard for assessment of left atrial and ventricular size. ^,

Severity of mitral regurgitation is the basis of management recommendations within the American College of Cardiology/American Heart Association valvular guidelines; therefore, accurate determination of severity is critical. ^, Symptoms of mitral regurgitation such as fatigue, dyspnea, and decreased exercise tolerance can also be seen in many common disease states and ensuring accurate diagnosis is key. Even more, when considering early surgery for asymptomatic patients, we must ensure an accurate quantification of mitral regurgitation severity. There is also significant importance placed on left ventricular ejection fraction and end-systolic dimension, which can often be better assessed with CMR.

CARDIAC MAGNETIC RESONANCE TECHNIQUES USED FOR ASSESSMENT OF MITRAL REGURGITATION