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Severe mitral regurgitation: relations between magnetic resonance imaging, echocardiography and natriuretic peptides
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.ORCID iD: 0000-0002-9198-4193
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
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2008 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 1, 48-55 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Assessment of the severity of mitral regurgitation by echocardiography can be technically demanding in certain patients and supplementary methods are therefore desirable. This study addressed the agreement between magnetic resonance imaging (MRI) and echocardiography, and their relations to natriuretic peptides (NT-proANP and NT-proBNP), in quantifying severe mitral regurgitation.

METHODS:

Eighteen patients with severe mitral regurgitation scheduled for surgery underwent MRI, echocardiography and assay of natriuretic peptides preoperatively for clinical assessment.

RESULTS:

MRI and echocardiography were comparable in measuring severity of regurgitation qualitatively but not quantitatively, mitral regurgitant fraction (mean difference 27.5 (11) ml). There was a correlation between increasing regurgitant fraction on MRI and increased levels of plasma NT-proANP and NT-proBNP. In echocardiography, increasing vena contracta width and increasing PISA correlated to increased levels of plasma NT-proANP and NT-proBNP. No other correlation was found between measures on MRI and echocardiography and natriuretic peptides.

CONCLUSIONS:

MRI and echocardiography were comparable grading the severity of mitral regurgitation with qualitative measures but not with quantitative measures. MRI might be a complement to echocardiography when a more distinct measure of the regurgitant volume is needed, as in paravalvular leakage.

Place, publisher, year, edition, pages
2008. Vol. 42, no 1, 48-55 p.
Keyword [en]
Magnetic resonance imaging, echocardiography, mitral regurgitation, natriuretic peptides
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-105143DOI: 10.1080/14017430701678691ISI: 000253122900006PubMedID: 17943627OAI: oai:DiVA.org:uu-105143DiVA: diva2:220546
Available from: 2009-06-01 Created: 2009-06-01 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Heart Valve Surgery: Preoperative Assessment and Clinical Outcome
Open this publication in new window or tab >>Heart Valve Surgery: Preoperative Assessment and Clinical Outcome
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A more global analysis of the outcome of heart valve surgery is desirable to reflect the actual benefit for the patient. This thesis focuses on the preoperative assessment of the patient, and the outcome after surgery with regard to operative mortality, long-term survival, valve-related complications, and quality of life.

Magnetic resonance imaging and echocardiography were comparable in assessing severe mitral regurgitation, but did not agree in measuring regurgitant fraction. Natriuretic peptides correlated well to regurgitant fraction on magnetic resonance imaging and to PISA and vena contracta on echocardiography.

The risk of death, myocardial injury and postoperative heart failure after valve surgery has decreased over the last decade whereas the proportion older patients has increased.

Survival is reduced after mitral valve replacement in patients with severe symptoms whereas patients with less symptoms have excellent survival. Older patients are more often severly symptomatic at the time of mitral valve surgery.

Event-free survival is superior in patients with a mechanical prosthesis, but not influenced by valve type in older patients. A mechanical prosthesis is associated with a higher risk of bleeding < 5 years from surgery, especially in older patients; and a bioprosthesis is associated with a higher risk of thromboembolism > 5 years from surgery. Ageing with a mechanical prosthesis implied an increased risk for an adverse event, this was not true for bioprostheses.

Quality of life after complicated heart valve surgery resulted in reduced physical health but equal mental health compared to uncomplicated controls.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 75 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 69
Keyword
Surgery, Heart valve surgery, magentic resonance imaging, echocardiography, operative mortality, survival, complications, quality of life, Kirurgi
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-5929 (URN)91-554-6336-3 (ISBN)
Public defence
2005-10-06, Robergsalen, Ing.40, Akademiska Sjukhuset, 751 85 Uppsala, 13:15
Opponent
Supervisors
Available from: 2005-09-15 Created: 2005-09-15 Last updated: 2013-09-13Bibliographically approved

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Hellgren, LailaStridsberg, MatsKvidal, PerStåhle, ElisabethBjerner, Tomas

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