IRM dans la quantification de l’insuffisance mitrale
Transcript of IRM dans la quantification de l’insuffisance mitrale
![Page 1: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/1.jpg)
IRM dans la quantification de l’insuffisance mitrale
Elie Mousseaux
Cardiovascular Imaging, Radiology DepartmentHôpital Européen Georges Pompidou
Université Paris Descartes, INSERM U 970, PARCC
![Page 2: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/2.jpg)
Insuffisance Mitrale Quantification
![Page 3: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/3.jpg)
Mitral Regurgitation : multimodal MR imagingEcho + CT ?
![Page 4: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/4.jpg)
Quantification?
![Page 5: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/5.jpg)
Quantification en IRM
![Page 6: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/6.jpg)
Mitral Regurgitation: quantification
Kar, Sharma, JACC 2015
![Page 7: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/7.jpg)
MR Volume = Left ventricle Stroke Volume – Ao Volume
![Page 8: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/8.jpg)
Left ventricle Stroke Volume
![Page 9: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/9.jpg)
Aortic Stroke Volume
MR volume = LVSV - AoSV= 92.6 – 30,6RV = 62ml
RF = 62 / 92 = 66%
![Page 10: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/10.jpg)
Gold Standard?
![Page 11: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/11.jpg)
Gold Standard
Hemodynamic response of the LV
ClinicalOutcomes
![Page 12: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/12.jpg)
From Uretsky CMR 2018
![Page 13: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/13.jpg)
Impact sur le VG: pas de relation entre quantification de l’IM écho et le remodelage post op (5-7 mois)
N = 103 Asymptomatic Patients Mild <30 ml ; Moderate 30 to 60 ml; Severe > 60 ml in CMR Urestky et al JACC 2015
![Page 14: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/14.jpg)
Uretsky et al JACC 2015
Patients with incomplete or suboptimal echocardiographic studies were excluded
Biner et al
![Page 15: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/15.jpg)
Volumic vs Full Phase Contrast approach
Le Goffic et al , AJC 2015
![Page 16: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/16.jpg)
Le Goffic et al , AJC 2015
The Reference method =
Volumic vs Full Phase Contrast approach
![Page 17: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/17.jpg)
IRM
•Seuil de dilatation VG ?
•Rvol >= 60 ml•RF >= 50% (why not 40% ??)
Sévérité IM à l’écho vs à l’IRM
![Page 18: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/18.jpg)
Sévérité de l’IM àl’échocardiographie
![Page 19: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/19.jpg)
Asymptomatic PatientsMR Moderate to severe on Echo-
derived integrative approachn=109
CMRMean F/u 2.5 y
Class I Indication for Surgery
•Symptoms (n=19)•ESD> 40 mm (n=4)•Onset of sPAP> 50 (n=2)
Surgeryn=25
No surgeryn=84
End Point
Severe OMR defined as RV > 60 ml
Myerson et al Circulation 2016
![Page 20: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/20.jpg)
Rvol >= 60 ml 55 ml ?
RF >= 50% 40 % ??
EDV > 100 ml/m² ?
ESV ??
Myerson et al Circulation 2016
![Page 21: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/21.jpg)
Asymptomatic PatientsMR Moderate to severe on Echo-
derived integrative approachn=258
CMRMean F/u 5 y
Or Class I or IIa of Indication for Surgery
•Symptoms•ESD> 45 mm or LV EF < 60%•PAPS>50mmHg•New onset of Atrial Fibrillation•Onset of PHT (sPAP> 50 at rest)
Surgeryn=25
No surgeryn=84
End PointAll cause Mortality
Penicka et al Circulation 2018
![Page 22: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/22.jpg)
Penicka et al Circulation 2018
![Page 23: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/23.jpg)
Good Agreement only if
holosystolic MR
central and single jet
Penicka et al Circulation 2018
![Page 24: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/24.jpg)
Ce résultat pose problème en raison du nombre de surestimation de l’IM à l’écho (35%)
Good Agreement only if
holosystolic MR
central and single jet
![Page 25: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/25.jpg)
Penicka et al Circulation 2018
Determinant de la mortalité en présence d’une IRM modérée ou sévère écho
Per 10 ml / m² > 35 ml/m²
![Page 26: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/26.jpg)
Penicka et al Circulation 2018
![Page 27: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/27.jpg)
Pitfall with MR quantification in CMR
• Error in ventricular volume ( especially basal slice)
• Phase Contrast slice orthogonal to vessel
• Background phase offset: vessel at isocenter, background or phantom correction
• Well choose velocity encoding
• Arrhythmia?
• Usual CMR limitations: Implanted devices, claustrophobia
![Page 28: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/28.jpg)
Going Further? Flux 4D, LGE, T1 ??
• 4D phase Contrast:
• 10 minutes
• Volumic Information
• No Validation For MR
• More Pitfalls than 2D PC
![Page 29: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/29.jpg)
Special Thanks:
G. Soulat, F.Pitocco, E. Charpentier, K.Dang Tran, U.Gencer, P.Garrigoux.
J Jouan, C Latremouille, A Berrebi service de chirurgie cardiaque HEGP
![Page 30: IRM dans la quantification de l’insuffisance mitrale](https://reader036.fdocuments.in/reader036/viewer/2022081701/62e33a4004f71553da373731/html5/thumbnails/30.jpg)
IRM est un bon complement de l’écho en cas de doute sur une IRM sévèreVolume Régurgitant +++, Fraction de Régurgitation et Volume télésystolique du VG
CONCLUSION