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Figure Legends:
Figure 1: Steady state free precession sequence (SSFP) demonstrating 3 chamber view with central dephasing jet of MR between the A2-P2 scallops of the mitral valve in one of our patients. MR: mitral regurgitation, LA: left atrium, RV: right ventricle, LV: left ventricle, LVOT: left ventricle outflow tract, AO: aorta
Figure 2: Steady state free precession sequence (SSFP) from our lab demonstrating 3 chamber view with anteriorly directed dephasing jet of MR with prolapse of the posterior mitral leaflet. MR: mitral regurgitation, LA: left atrium, RV: right ventricle, LV: left ventricle, LVOT: left ventricle outflow tract, AO: aorta
Figure 3a: Steady state free precession sequence (SSFP) from our lab demonstrating 3 chamber view with flail posterior mitral valve leaflet with eccentric jet of mitral regurgitation (white arrow). MR: mitral regurgitation, LA: left atrium, RV: right ventricle, LV: left ventricle, LVOT: left ventricle outflow tract, AO: aorta
Figure 3b: Steady state free precession sequence (SSFP) from our lab demonstrating 4 chamber view with subtle flail posterior mitral valve leaflet with eccentric jet of mitral regurgitation (white arrow). MR: mitral regurgitation, LA: left atrium, RV: right ventricle, LV: left ventricle, LVOT: left ventricle outflow tract, AO: aorta
Figure 4: Example CMR method for quantification of MR. The volume of the LV is calculated during end-diastole (LVEDV) and during end-systole (LVESV). The total volume of blood ejected from the left ventricle (LV), LV SV, is computed as the difference between LV end-diastolic volume and LV end-systolic volume. In this example LV SV is 150 mL. The volume of blood crossing the aortic (AO) valve is measured by performance of a phase-contrast acquisition in the aorta; in this example, 80 mL. The mitral RVol (M RVol) is computed as the difference between the LV SV and aortic forward SV; in this example, 70 mL. Reused with permission from Zoghbi, William A., et al. ”Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance.” Journal of the American Society of Echocardiography 30.4 (2017): 303-371.
Figure 5: Recommended cardiovascular magnetic resonance imaging protocols for the assessment of mitral regurgitation. a Comprehensive cardiovascular magnetic resonance imaging protocol for the assessment of mitral regurgitation. b Focused, quantitative protocol. LGE, late gadolinium enhancement; LV, left ventricular; LVOT, left ventricular outflow tract; RVOT, right ventricular outflow tract. Reused under Creative Commons Attribution 4.0 International Licence from Fig 1 in Garg, Pankaj, et al. ”Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging.” Nature Reviews Cardiology (2019): 1-15.
Figure 6: Depiction of mechanisms of MR as per the Carpentier classification
Reused with permission from Zoghbi, William A., et al. ”Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance.” Journal of the American Society of Echocardiography 30.4 (2017): 303-371.
Figure 7a: Steady state free precession sequence (SSFP) from our lab demonstrating 3 chamber view in a patient with hypertrophic cardiomyopathy with asymmetric septal hypertrophy and LVOT and SAM with dense dephasing jet of MR
RV: Right ventricle, LV: Left ventricle, LA: Left atrium, Ao: Ascending aorta, PM: Papillary muscle, LVOT: Left ventricular outflow tract turbulence, SAM: Systolic anterior motion, MR: Mitral regurgitation
Figure 7b: Steady state free precession sequence (SSFP) demonstrating of the same patient with hypertrophic cardiomyopathy showing two separate jets of MR in a coronal view. LV: Left ventricle, RV: Right Ventricle, AO: Ascending aorta, PA: Pulmonary artery, MR: Mitral Regurgitation
Figure 7c: Magnitude inversion recovery late gadolinium enhanced (LGE) sequence demonstrating diffuse patchy hyperenhancement most prominent in the inferolateral wall in the same patient with hypertrophic obstructive cardiomyopathy and mitral regurgitation. RV: Right ventricule, IVS: Interventricular septum, LV: Left Ventricle
Figure 8: Surgery-free survival stratified by both cardiovascular magnetic resonance (CMR) regurgitant volume (RVol) and left ventricular end-diastolic volume index (LVEDVi; Note that there were too few subjects [n=2] with CMR regurgitant volume ≤55 mL and LVEDVi ≥100 mL/m2, so this group was excluded). B , CMR regurgitant volume and echocardiographic mitral regurgitation (MR) grade. Note that the group with CMR regurgitant volume >55 mL and moderate MR on echocardiography contains only 5 subjects. Reused with permission from Myerson, Saul G., et al. ”Determination of clinical outcome in mitral regurgitation with cardiovascular magnetic resonance quantification.” Circulation 133.23 (2016): 2287-2296.