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DOI: 10.1055/s-0034-1394005
The Total Right / Left - Volume - Index: A new and simplified CMR measure to evaluate the severity of Ebstein’s anomaly of the tricuspid valve
Background: The classification of clinical severity of Ebstein’s Anomaly (EA) remains a challenge. Aim of this study was to derive from cardiac magnetic resonance (CMR) a simple imaging measure for the clinical severity of EA.
Methods and Results: 25 patients (mean age 26±14) with unrepaired EA were examined in a prospective study. Disease severity was classified using CMR volumes and functional measurements compared to heart failure markers from clinical data, ECG, laboratory, exercise testing and echocardiography. A Total Right/Left-Volume-Index was defined in end diastole as (RA+aRV+fRV)÷(LA+LV). Mean Total R/L-Volume-Index was 2.6±1.7. The new Total R/L-Volume-Index correlated with most clinically employed heart failure markers: BNP (r=0.691,p=0.0003), QRS (r=0.432,p=0.039), peak VO2/kg (r=-0.479,p=0.024), VE/VCO2 (r=0.426,p=0.048), severity of tricuspid regurgitation (r=0.692,p=0.009), tricuspid valve offset (r=0.583,p=0.004) and TAPSE (r=0.554,p=0.006). Previously described severity indices corresponded only to some parameters.
Conclusions: In patients with EA, the easily acquired index of right sided to left sided heart volumes from CMR correlated well with established heart failure markers and should be used as a new and simplified CMR measure, allowing more accurate assessment of disease severity.