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Scoring model based on cardiac CT and clinical factors to predict early good mitral valve repair in rheumatic mitral disease

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A Commentary to this article was published on 26 January 2024

Abstract

Objective

We aimed to evaluate the mitral valve calcification and mitral structure detected by cardiac computed tomography (cardiac CT) and establish a scoring model based on cardiac CT and clinical factors to predict early good mitral valve repair (EGMR) and guide surgical strategy in rheumatic mitral disease (RMD).

Materials and methods

This is a retrospective bi-center cohort study. Based on cardiac CT, mitral valve calcification and mitral structure in RMD were quantified and evaluated. The primary outcome was EGMR. A logical regression algorithm was applied to the scoring model.

Results

A total of 579 patients were enrolled in our study from January 1, 2019, to August 31, 2022. Of these, 443 had baseline cardiac CT scans of adequate quality. The calcification quality score, calcification and thinnest part of the anterior leaflet clean zone, and papillary muscle symmetry were the independent CT factors of EGMR. Coronary artery disease and pulmonary artery pressure were the independent clinical factors of EGMR. Based on the above six factors, a scoring model was established. Sensitivity = 95% and specificity = 95% were presented with a cutoff value of 0.85 and 0.30 respectively. The area under the receiver operating characteristic of external validation set was 0.84 (95% confidence interval [CI] 0.73–0.93).

Conclusions

Mitral valve repair is recommended when the scoring model value > 0.85 and mitral valve replacement is prior when the scoring model value < 0.30. This model could assist in guiding surgical strategies for RMD.

Clinical relevance statement

The model established in this study can serve as a reference indicator for surgical repair in rheumatic mitral valve disease.

Key Points

• Cardiac CT can reflect the mitral structure in detail, especially for valve calcification.

• A model based on cardiac CT and clinical factors for predicting early good mitral valve repair was established.

• The developed model can help cardiac surgeons formulate appropriate surgical strategies.

Graphical abstract

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Abbreviations

ALCZ:

Anterior mitral leaflet clean zone

Cardiac CT:

Cardiac computed tomography

CI:

Confidence interval

EGMR:

Early good mitral valve repair

MPR:

Multiplanar reformation

RMD:

Rheumatic mitral disease

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Acknowledgements

We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.

The data that support the findings of this study are available from the RDR database (http://118.26.69.165:23023/RDR/login.html), but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission.

Funding

This study has received funding by grants from the National Natural Science Foundation of China (82170487, U1908211, 82271986), the 2022 China Association for Science and Technology Think Tank Youth Talent Plan (KCZD202203), the Capital’s Funds for Health Improvement and Research Foundation of China (2020-1-1052), and major scientific and technological innovation research and development project of Beijing Anzhen Hospital affiliated to Capital Medical University and High-End Foreign Experts Introduction Plan (G2022001039L).

Author information

Author notes

  1. Maozhou Wang, Hongkai Zhang, and Zhou Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China

    Maozhou Wang, Jie Han, Wenjie Tang, Peiyi Liu, Baiyu Tian, Tiange Luo, Jiangang Wang, Xu Meng, Hongjia Zhang & Wenjian Jiang

  2. Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Vascular Diseases, Capital Medical University, Beijing, China

    Hongkai Zhang, Nan Zhang, Shuang Li & Lei Xu

  3. Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing, China

    Zhou Liu & Jing Liu

  4. Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China

    Zhou Liu & Jing Liu

  5. Department of Cardiothoracic Surgery, Zhongshan City People’s Hospital, Sun Wenzhong Road, Zhongshan, China

    Hongyu Ye

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Corresponding authors

Correspondence to Hongyu Ye, Lei Xu, Hongjia Zhang or Wenjian Jiang.

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Guarantor

The scientific guarantor of this publication is Dr. Wenjian Jiang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Jing Liu has significant statistical expertise and kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained. Our research program was approved by the Ethics Committee of Beijing Anzhen Hospital (KS2022078), and the privacy and personally identifiable information of the subjects were protected; therefore, the requirement for informed consent was waived. Clinical registration number: ChiCTR2200067151.

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported before.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study, performed at two institutions

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Wang, M., Zhang, H., Liu, Z. et al. Scoring model based on cardiac CT and clinical factors to predict early good mitral valve repair in rheumatic mitral disease. Eur Radiol (2024). https://doi.org/10.1007/s00330-023-10470-0

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  • DOI: https://doi.org/10.1007/s00330-023-10470-0

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