1/
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)

2/
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

3/
#WhyCMR for Primary MR
CIRC ‘17CMR severe-TTE moderate MR outcomes similar to CMR severe-TTE-severe MR.
JACC ‘15correlation of MR estimates by #WhyCMR & #echofirst in pts referred to MV Sx.
correlation b/w post-op LV remodeling & baseline MR severity by CMR

4/
AJC 2020evidence 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.

5/
#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

6/
#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

7/
JACC 2019patients 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.

8/
Catheter Cardiviasc Interv. 2019MF by #WhyCMR LGE also a/w post #mitraclip adverse outcomes.

9/
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!

10/
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.

11/
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.