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. 2022 May;15(5):747-760.
doi: 10.1016/j.jcmg.2021.10.006. Epub 2022 Jan 12.

American Society of Echocardiography Algorithm for Degenerative Mitral Regurgitation: Comparison With CMR

Seth Uretsky  1 , Islamiyat Babs Animashaun  2 , Sakul Sakul  3 , Lillian Aldaia  2 , Leo Marcoff  2 , Konstantinos Koulogiannis  2 , Edgar Argulian  3 , Mark Rosenthal  2 , Steven D Wolff  4 , Linda D Gillam  2
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Free article

American Society of Echocardiography Algorithm for Degenerative Mitral Regurgitation: Comparison With CMR

Seth Uretsky et al. JACC Cardiovasc Imaging. 2022 May.
Free article

Abstract

Objectives: The purpose of this study was to compare the American Society of Echocardiography (ASE) algorithm for assessing mitral regurgitation (MR) to cardiac magnetic resonance (CMR) and left ventricular (LV) remodeling following mitral intervention.

Background: The ASE recommends integrating multiple echocardiographic parameters for assessing MR. The ASE guidelines include an algorithm that weighs the parameters and highlights those considered indicative of definitely mild or definitely severe MR.

Methods: We prospectively enrolled 152 (age 62 ± 13 years; 59% male) patients with degenerative MR who underwent ASE algorithm-guided echocardiographic and CMR grading of MR severity. Using the ASE algorithm, patients were graded as definitely mild, grade I, grade II, grade III, grade IV, or definitely severe MR. CMR MR volume was graded as mild (<30 mL), grade II moderate (30-44 mL), grade III moderate (45-59 mL), or severe (≥60 mL). A subgroup of 63 patients underwent successful mitral intervention, of whom 48 had postintervention CMR.

Results: Only 52% of patients with definitely severe MR by the ASE algorithm had severe MR by CMR, and 10% had mild MR by CMR. There was an increase in post mitral intervention LV reverse remodeling with worsening MR severity using CMR (P < 0.0001) but not the ASE algorithm (P = 0.07). Severe MR by CMR was an independent predictor of post mitral intervention LV reverse remodeling and definitely severe MR by the ASE algorithm was not.

Conclusions: In patients with degenerative MR, agreement between CMR and the ASE algorithm was suboptimal. Severe MR by CMR was an independent predictor of post mitral intervention LV reverse remodeling, whereas definitely severe MR by the ASE algorithm was not. These findings suggest an important role for CMR in surgical decision making in degenerative MR. (Comparison Study of Echocardiography and Cardiovascular Magnetic Resonance Imaging in the Assessment of Mitral and Aortic Regurgitation; NCT04038879).

Keywords: cardiac magnetic resonance; degenerative mitral regurgitation; echocardiography; mitral regurgitation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Wolff is the owner of NeoSoft LLC and NeoCoil LLC. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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