Assessment of mitral valve: Comparison of transthoracic echocardiography and cardiac magnetic resonance imaging

Introduction: Mitral Stenosis (MS) which is almost always developed as a complication of acute rheumatic fever is one of the worldwide important causes of mortality and morbidity. The treatment strategy of MS depends on MS severity and especially mitral valve area. For this reason, assessment of MS and its severity, anatomic evaluation of the mitral valve and presence concomitant valve diseases with non-invasive diagnostic tools is very important.Purpose: To evaluate planimetric mitral valve area (MVA), mitral leaflet separation (MLS) index and diastolic flow velocities of isolated mitral valve stenosis patients with sinus rhythm with transthoracic echocardiography (TTE) and to compare these measurements with cardiac magnetic resonance imaging (CMRI).Material and Methods: 28 (90.3%) women, 3 (9.7%) men, a total number of 31 patients who were in sinus rhythm and who had MS in TTE were included. Patients with, EF <50%, with AF, mitral valve insufficiency more than mild degree, stenosis and insufficiency in other valves more than mild degree and patients who had previous comissurotomy and valvulotomy were excluded. CMRI was performed in an hour after detailed TTE examining. Planimetric MVA, MLS index, diastolic velocities were measured with TTE and results were compared with the measurements of CMRI.Results: Strong correlation was found between TTE and CMRI in the measurements of planimetric MVA, MLS index, peak E, peak A velocities, (in order r= 0,948, r= 0,971, r= 0,786, r= 0,839; p<0,0001). When patients were divided into groups as mild MS and moderate-severe MS, again strong correlations between the two methods were observed. CMRI?s sensitivity, specify, negative and positive predictive values were found 84,2%, 100%, 80% , 100% in patients with MKA<1.5 in TTE measurements.Conclusion: Strong correlation was found between CMRI and TTE in the measurements of planimetric MVA, MLS index and diastolic flow velocities. As a result of our findings, we believe CMRI was a complementary method in MS diagnosis and follow-up especially when echocardiography data was insufficient or there was discrepancy between clinic of the patient and catheterization and echocardiographic findings.