Comparative Imaging Assessment of Valvular Heart Disease
Comparative Imaging Assessment of Valvular Heart Disease
The purpose of the study is to compare the various 2D and 3D methods of valvular heart
 disease quantification (Doppler, PISA, VCA, volumetric method) and strain with cardiac
 magnetic resonance (CMR) measurements of left and right ventricular systolic function strain
 and myocardial fibrosis assessment.
The objective of this study is to compare the accuracy of 3D TTE to 2D TTE in assessing the
 severity of valvular heart disease in patients with aortic stenosis, aortic regurgitation,
 and mitral valve regurgitation by comparing this to the reference standard of cardiac
 magnetic resonance (CMR) in subjects with different etiologies and mechanisms of valvular
 lesions and to the integrative method of valvular lesion grading as recommended by
 inter-societal guidelines. Another objective is to assess prevalence of focal and diffuse
 myocardial fibrosis as assessed by CMR in patients with aortic stenosis, aortic regurgitation
 and mitral regurgitation. In addition, the investigators aim to determine whether severity of
 myocardial fibrosis predicts onset of symptoms, referral for valve surgery and adverse
 ventricular remodeling. The investigators also aim to look at patients who will be undergoing
 CRT implant to predict their response to therapy.

 At baseline, the Rapid Assessment of Physical Activity questionnaire and the Kansas City
 Cardiomyopathy Questionnaire will be completed. A 6 month follow-up is required and will
 include an abbreviated non-contrast research cardiac MRI and subject questionnaires. At 1
 year, subject questionnaires will again be required.

 Other follow-up will include using electronic medical records and the Social Security Death
 Index database for outcomes such as death, hospitalization for heart failure, mitral or
 aortic valve interventions and cardiovascular death.

 Select patients will be asked to undergo a supine bicycle exercise stress MRI at enrollment.
 Approximately 40 subjects will be included in this substudy.

 Additional exclusion criteria for this substudy:

 -  Unable to pedal a supine bicycle

 -  Require supplemental oxygen

 During the exercise stress MRI, patients will be asked to cycle on a supine bike that will be
 mounted on the MRI platform. During this test, a caregiver will be present. An
 electrocardiogram (ECG) will be used to obtain tracings of cardiac activity. Respirations,
 blood pressure, and heart rate are also monitored during exercise. The test is continued
 until peak exercise level or target heart rate is achieved. As soon as the exercise portion
 is complete, MRI images will be acquired. When the test is complete, patients will be
 monitored until ECG, heart rate, and breathing have returned to baseline. Patients will be
 assessed for symptoms such as chest pain, dyspnea, leg pain, dizziness, or fatigue and may be
 given medications or instructed to stop the test early as necessary.
Inclusion Criteria:

 -  Age 18-90 years of age

 -  Suspected moderate or severe MR,AR or AS on the basis of prior known clinical history
 or clinical exam.

 -  Suspected CRT "non-responder" with an implanted MRI compatible CRT device and reduced
 ejection fraction

 Exclusion Criteria:

 -  Acute traumatic cardiac injury

 -  Aortic dissection or aortic root rupture

 -  Congenital heart diseases such as patent ductus arteriosus, coarctation of aorta, ASD
 and VSD

 -  Presence of A-V fistula or intracardiac shunts

 -  Any contraindications to CMR

 -  Moderate or severe dysfunction in multiple valves

 -  Patients with significant claustrophobia