Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness.

The echocardiographic assessment of mitral valve regurgitation (MR) by characterizing specific morphological features and grading its severity is still challenging. Analysis of MR etiology is necessary to clarify the underlying pathological mechanism of the valvular defect. Severity of mitral regurgitation is often quantified based on semi-quantitative parameters. However, incongruent findings and/or interpretations of regurgitation severity are frequently observed. This proposal seeks to offer practical support to overcome these obstacles by offering a standardized workflow, an easy means to identify non-severe mitral regurgitation, and by focusing on the quantitative approach with calculation of the individual regurgitant fraction. This work also indicates main methodological problems of semi-quantitative parameters when evaluating MR severity and offers appropriateness criteria for their use. It addresses the diagnostic importance of left-ventricular wall thickness, left-ventricular and left atrial volumes in relation to disease progression, and disease-related complaints to improve interpretation of echocardiographic findings. Finally, it highlights the conditions influencing the MR dynamics during echocardiographic examination. These considerations allow a reproducible, verifiable, and transparent in-depth echocardiographic evaluation of MR patients ensuring consistent haemodynamic plausibility of echocardiographic results.

Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging.

OBJECTIVE: Previous studies determined the amount of epicardial fat by measuring the right ventricular epicardial fat thickness. However, it is not proven whether this one-dimensional method correlates well with the absolute amount of epicardial fat. In this prospective study, a new cardiovascular magnetic resonance imaging (CMR) method using the three-dimensional summation of slices method was introduced to assess the total amount of epicardial fat. RESEARCH METHODS AND PROCEDURES: CMR was performed in 43 patients with congestive heart failure and in 28 healthy controls. The absolute amount of epicardial fat was assessed volumetrically in consecutive short-axis views by means of the modified Simpson's rule. Additionally, the right ventricular epicardial fat thickness was measured in two different imaging planes: long-axis view (EFT-4CV) and consecutive short-axis views (EFT-SAX). RESULTS: Using the volumetric approach, patients with congestive heart failure had less epicardial fat mass than controls (51 g vs. 65 g, p=0.01). This finding was supported by EFT-SAX (2.9 mm vs. 4.3 mm, p<0.0001) but not by EFT-4CV (3.5 mm vs. 3.8 mm, p=not significant). Epicardial fat mass correlated moderately with EFT-SAX in both groups (r=0.466, p=0.012 in controls and r=0.590, p<0.0001 in patients) and with EFT-4CV in controls (r=0.387, p=0.042). There were no significant differences between EFT-4CV and EFT-SAX in controls (4.3 mm vs. 3.8 mm, p=0.240). However, in the heart failure group, EFT-4CV was significantly higher compared with EFT-SAX (3.5 mm vs. 2.9 mm, p=0.003). Interobserver variability and reproducibility were superior for the volumetric approach compared with thickness measurements. DISCUSSION: Quantitative assessment of epicardial fat mass using the CMR-based volumetric approach is feasible and yields superior reproducibility compared with conventional methods.