CMR predictors of mortality in valve disease (BSCMR)
Research type
Research Study
Full title
CMR predictors of mortality in patients with aortic and mitral regurgitation: from the BSCMR Valve Consortium
IRAS ID
311412
Contact name
Richard P Steeds
Contact email
Sponsor organisation
University of Birmingham
Duration of Study in the UK
15 years, 0 months, 1 days
Research summary
This multicentre observational study intends to amass patients who have had cardiovascular magnetic resonance (CMR) imaging for prior research purposes for aortic regurgitation (AR) and mitral regurgitation (MR), or in the course of routine clinical care from patients from across the UK. The aim is to identify prognostic CMR parameters which can guide patient selection for intervention.
AR and MR are amongst the most common valve diseases worldwide. Prevalence increases significantly with advancing age, such that clinically significant AR and MR are present in >13% of patients aged over 70, becoming more prevalent with increasing life expectancy. Left untreated, patients eventually present with breathlessness and/or oedema due to heart failure.
Treatment primarily involves surgical valve replacement or repair. Select MR patients deemed at prohibitive surgical risk may be treated by transcatheter repair. Determining eligibility for intervention (particularly in asymptomatic individuals) currently centres on the measurement of ventricular dimensions and function on echocardiography. However, it is well established that these measurements are affected by interobserver variability, resulting in suboptimal consistency. Moreover, assessment is extremely challenging in patients with poor echo windows and underestimation of severity can easily occur in patients with multiple or eccentric jets. CMR is the gold standard method of assessing ventricular size, structure and function and can assess the severity of regurgitant lesions independently of jet size or eccentricity. Studies have demonstrated significant improvement in variability of quantification using CMR compared to echocardiography. Furthermore, the severity of regurgitation may not be directly predictive of patient outcomes as patients with severe valve regurgitation may remain asymptomatic with normal ventricular function for many years. Instead, progressive subclinical myocardial remodelling, quantifiable on CMR, may be the mechanism via which patients develop overt heart failure. However, the role of CMR in the diagnostic work-up of patients with these valvular lesions requires further study.
REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
24/WM/0012
Date of REC Opinion
19 Jan 2024
REC opinion
Favourable Opinion