Thorac Cardiovasc Surg 2014; 62 - v29
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

O. Hösch 1, J. M. Sohns 2, T. T. Nguyen 1, P. Lauerer 1, J. Kowallick 2, C. Unterberg 2, A. Schuster 3, S. Kutty 4, M. Faßhauer 2, W. Staab 2, T. Paul 1, J. Lotz 2, M. Steinmetz 1
  • 1Klinik für Pädiatrische Kardiologie und Intensivmedizin, Herzzentrum, Universitätsmedizin Göttingen
  • 2Institut für Diagn. und Intervent. Radiologie, Herzzentrum, Universitätsmedizin Göttingen
  • 3Klinik für Kardiologie und Pneumologie, Herzzentrum, Universitätsmedizin Göttingen
  • 4University of Nebraska Medical Center, Omaha, NE, USA

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.