4D Flow CMR The Final Frontier in Valvular Heart Disease?

chocardiography has traditionally been the first-line modality for imaging patients with valvular regurgitation. In addition to assessing the severity of valve regurgitation, it can provide insights into the mechanism, evaluate chamber sizes, and assess pulmonary artery pressures, all markers of the consequences of valve lesions. However, echocardiography may be suboptimal in some instances due to body habitus or lung disease, which can result in poor acoustic windows. In other cases, even a good quality echocardiogram may produce discordant findings between the elements of the 2-dimensional (2D), Doppler, and physical examination. In all of these situations, cardiovascular magnetic resonance (CMR) has emerged as a modality of choice at many institutions. CMR allows not only quantitation of valvular regurgitation, but also a robust assessment of cardiac chamber sizes and can provide insight into the mechanism of regurgitation. Unique information provided by CMR is on the direct health of myocardial tissue. Late gadolinium enhancement CMR has demonstrated the ability to detect myocardial scarring sequelae in aortic stenosis (1) and mitral valve prolapse (2). Newer CMR techniques using T1 mapping allow assessment of expanded extracellular space, which is thought to be a surrogate for diffuse interstitial fibrosis (3,4). In the past few years, numerous studies have linked these CMR measures of myocardial remodeling with clinical outcomes in patients with valvular heart disease (1-4 ).

Automated summary

Echocardiography has been the primary tool for evaluating valvular regurgitation, but may have limitations in certain cases. Cardiovascular magnetic resonance (CMR) has emerged as the preferred modality for many institutions, offering a comprehensive assessment and direct health information on myocardial tissue.