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Comprehensive talk by Dr. @JoaoLCavalcante who who patiently walked us through #WhyCMR in Mitral Regurgitation.
First: different etiologies of MR where #WhyCMR may be applicable:
🧲Primary MR
🧲Arrhythmogenic MVP phenotype (including MAD)
🧲Secondary MR (work in progress)
Limitations of #echofirst:
🧲overestimation of MR by PISA, underestimation of eccentric MR.
🧲poor reproducibility if MR severity (inter- and intra-observer)
🧲Alas, there is no accuracy without reproducibility 👎🏻
#WhyCMR for Primary MR➡️
🧲CIRC ‘17➡️CMR severe-TTE moderate MR outcomes similar to CMR severe-TTE-severe MR.
🧲JACC ‘15➡️👎🏻correlation of MR estimates by #whycmr & #echofirst in pts referred to MV Sx.
🧲💪🏻 correlation b/w post-op LV remodeling & baseline MR severity by CMR
🧲AJC 2020➡️evidence for strong correlation between predicted and observed change in post-MR “correction” LVEDV based on baseline MR severity by #whyCMR. 🧲Greater superiority of #WhyCMR when quantifying post #mitraclip residual MR.
#WhyCMR for arrhythmogenic MVP phenotype:
🧲⬆️prevalence of MF in MVP vs non MVP & greater w/ ⬆️LV remodeling & ⬆️MR severity.
🧲”interstitial ❤️ disease” described >40 yrs ago in 💀 ❤️s w/ chronic vol/pressure overload.
🧲#whycmr helps identify structural myocardial changes
#WhyCMR in FMR:
🧲ongoing attempts at quantifying & characterizing significant FMR to help triage patients for appropriate therapies.
🧲FMR is a dz of the LV.
🧲Need better assessment of LV “health” and #echofirst with abundant limitations in this regard.
🧲Enter #WhyCMR
🧲JACC 2019➡️patients with ICM+ FMR,MIS quantified by LGE.
🧲on multivariable analysis, interaction of MIS & IMR was a 💪🏻 predictor of adverse outcomes.
🧲subgrp analysis: pts w/ subsequent CABG+MVR had better outcomes if significant FMR but ⬇️ MIS at baseline.
🧲Catheter Cardiviasc Interv. 2019➡️MF by #WhyCMR LGE also a/w post #mitraclip adverse outcomes.
Well then, let’s bust some common myths about #WhyCMR: See myths below.
1) busted by Dr. @cshenoy3, see below⬇️
2)same machine used for knees, brain and ❤️. Just need #WhyCMR software and training.
3)CAN be done in pts with PPM, ICDs (it’s 2020!!)
4)Read thread from the top!
In conclusion:
🧲Use #WhyCMR when discordance b/w clinical and echo Doppler findings OR suboptimal echo images OR pts with FMR to establish etiology and assess scar burden.
🧲Growing role for #WhyCMR given reproducibility, prediction of LV remodeling and diagnosing MF.
Thanks very much, Dr. @JoaoLCavalcante for such a detailed talk, from basics to more advanced and for answering my question about 3D ECHO.

Those interested in learning more, check out this upcoming workshop by @MHIF_Heart.
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