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IRM dans la quantification de linsuffisance mitrale Elie Mousseaux - - PowerPoint PPT Presentation
IRM dans la quantification de linsuffisance mitrale Elie Mousseaux - - PowerPoint PPT Presentation
IRM dans la quantification de linsuffisance mitrale Elie Mousseaux Cardiovascular Imaging, Radiology Department Hpital Europen Georges Pompidou Universit Paris Descartes, INSERM U 970, PARCC Insuffisance Mitrale Quantification
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Mitral Regurgitation : multimodal MR imaging Echo + CT ?
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Quantification?
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Quantification en IRM
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Mitral Regurgitation: quantification
Kar, Sharma, JACC 2015
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MR Volume = Left ventricle Stroke Volume – Ao Volume
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Left ventricle Stroke Volume
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Aortic Stroke Volume
MR volume = LVSV - AoSV = 92.6 – 30,6 RV = 62ml RF = 62 / 92 = 66%
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Gold Standard?
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Gold Standard
Hemodynamic response of the LV Clinical Outcomes
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From Uretsky CMR 2018
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Impact sur le VG: pas de relation entre quantification de l’IM écho et le remodelage post
- p (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
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Uretsky et al JACC 2015
Patients with incomplete or suboptimal echocardiographic studies were excluded
Biner et al
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Volumic vs Full Phase Contrast approach
Le Goffic et al , AJC 2015
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Le Goffic et al , AJC 2015 The Reference method =
Volumic vs Full Phase Contrast approach
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IRM
- Seuil de dilatation VG ?
- Rvol >= 60 ml
- RF >= 50% (why not 40% ??)
Sévérité IM à l’écho vs à l’IRM
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Sévérité de l’IM à l’échocardiographie
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Asymptomatic Patients MR Moderate to severe on Echo- derived integrative approach n=109 CMR Mean F/u 2.5 y Class I Indication for Surgery
- Symptoms (n=19)
- ESD> 40 mm (n=4)
- Onset of sPAP> 50 (n=2)
Surgery n=25 No surgery n=84
End Point Severe OMR defined as RV > 60 ml Myerson et al Circulation 2016
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Rvol >= 60 ml 55 ml ? RF >= 50% 40 % ?? EDV > 100 ml/m² ? ESV ?? Myerson et al Circulation 2016
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Asymptomatic Patients MR Moderate to severe on Echo- derived integrative approach n=258 CMR Mean 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)
Surgery n=25 No surgery n=84
End Point All cause Mortality Penicka et al Circulation 2018
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Penicka et al Circulation 2018
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Good Agreement only if holosystolic MR central and single jet
Penicka et al Circulation 2018
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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
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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
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Penicka et al Circulation 2018
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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
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Going Further? Flux 4D, LGE, T1 ??
- 4D phase Contrast:
- 10 minutes
- Volumic Information
- No Validation For MR
- More Pitfalls than 2D PC
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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
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