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Review

Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce?

by
Francesca Baessato
1,2,†,
Laura Fusini
3,4,5,*,†,
Manuela Muratori
3,
Gloria Tamborini
3,
Sarah Ghulam Ali
3,
Valentina Mantegazza
3,
Andrea Baggiano
3,
Saima Mushtaq
3,
Mauro Pepi
3,
Giuseppe Patti
5,6 and
Gianluca Pontone
3,7
1
Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, 80636 Munich, Germany
2
Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy
3
Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
4
Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133 Milan, Italy
5
Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
6
Division of Cardiology, Maggiore della Carità Hospital, 28100 Novara, Italy
7
Department of Biomedical, Surgical and Dental Sciences, University of Milan, 2012 Milan, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Cardiovasc. Dev. Dis. 2023, 10(4), 150; https://doi.org/10.3390/jcdd10040150
Submission received: 28 February 2023 / Revised: 27 March 2023 / Accepted: 29 March 2023 / Published: 31 March 2023
(This article belongs to the Special Issue Mitral Valve Prolapse and Mitral Regurgitation)
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Abstract

Quantification of chronic mitral regurgitation (MR) is essential to guide patients’ clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and quantitative parameters. Of note, quantitative parameters, such as the echocardiographic effective regurgitant orifice area, regurgitant volume (RegV), and regurgitant fraction (RegF), are considered the most reliable indicators of MR severity. In contrast, cardiac magnetic resonance (CMR) has demonstrated high accuracy and good reproducibility in quantifying MR, especially in cases with secondary MR; nonholosystolic, eccentric, and multiple jets; or noncircular regurgitant orifices, where quantification with echocardiography is an issue. No gold standard for MR quantification by noninvasive cardiac imaging has been defined so far. Only a moderate agreement has been shown between echocardiography, either with transthoracic or transesophageal approaches, and CMR in MR quantification, as supported by numerous comparative studies. A higher agreement is evidenced when echocardiographic 3D techniques are used. CMR is superior to echocardiography in the calculation of the RegV, RegF, and ventricular volumes and can provide myocardial tissue characterization. However, echocardiography remains fundamental in the pre-operative anatomical evaluation of the mitral valve and of the subvalvular apparatus. The aim of this review is to explore the accuracy of MR quantification provided by echocardiography and CMR in a head-to-head comparison between the two techniques, with insight into the technical aspects of each imaging modality.
Keywords: mitral regurgitation; mitral valve prolapse; echocardiography; cardiovascular magnetic resonance; multimodality imaging; mitral valve surgery mitral regurgitation; mitral valve prolapse; echocardiography; cardiovascular magnetic resonance; multimodality imaging; mitral valve surgery

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MDPI and ACS Style

Baessato, F.; Fusini, L.; Muratori, M.; Tamborini, G.; Ghulam Ali, S.; Mantegazza, V.; Baggiano, A.; Mushtaq, S.; Pepi, M.; Patti, G.; et al. Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce? J. Cardiovasc. Dev. Dis. 2023, 10, 150. https://doi.org/10.3390/jcdd10040150

AMA Style

Baessato F, Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Mantegazza V, Baggiano A, Mushtaq S, Pepi M, Patti G, et al. Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce? Journal of Cardiovascular Development and Disease. 2023; 10(4):150. https://doi.org/10.3390/jcdd10040150

Chicago/Turabian Style

Baessato, Francesca, Laura Fusini, Manuela Muratori, Gloria Tamborini, Sarah Ghulam Ali, Valentina Mantegazza, Andrea Baggiano, Saima Mushtaq, Mauro Pepi, Giuseppe Patti, and et al. 2023. "Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce?" Journal of Cardiovascular Development and Disease 10, no. 4: 150. https://doi.org/10.3390/jcdd10040150

APA Style

Baessato, F., Fusini, L., Muratori, M., Tamborini, G., Ghulam Ali, S., Mantegazza, V., Baggiano, A., Mushtaq, S., Pepi, M., Patti, G., & Pontone, G. (2023). Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce? Journal of Cardiovascular Development and Disease, 10(4), 150. https://doi.org/10.3390/jcdd10040150

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