A comparison of the clinical efficacy of echocardiography and magnetic resonance for chronic aortic regurgitation

2020 ◽  
Author(s):  
Andrea Postigo ◽  
Esther Pérez-David ◽  
Ana Revilla ◽  
Ladrón Abia Raquel ◽  
Ana González-Mansilla ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Regurgitation ◽  
Clinical Efficacy ◽  
Primary Endpoint ◽  
Left Ventricular ◽  
Regurgitant Fraction ◽  
End Diastolic Volume ◽  
Asymptomatic Patients ◽  
Severity Of The Disease ◽  
Chronic Aortic Regurgitation

Abstract Aims Timing surgery in chronic aortic regurgitation (AR) relies mostly on echocardiography. However, cardiac magnetic resonance (CMR) may be more accurate for quantifying regurgitation and left ventricular (LV) remodelling. We aimed to compare the technical and clinical efficacies of echocardiography and CMR to account for the severity of the disease, the degree of LV remodelling, and predict AR-related outcomes. Methods and results We studied 263 consecutive patients with isolated AR undergoing echocardiography and CMR. After a median follow-up of 33 months, 76 out of 197 initially asymptomatic patients reached the primary endpoint of AR-related events: 6 patients (3%) were admitted for heart failure, and 70 (36%) underwent surgery. Adjusted survival models based on CMR improved the predictions of the primary endpoint based on echocardiography: R2 = 0.37 vs. 0.22, χ2 = 97 vs. 49 (P < 0.0001), and C-index = 0.80 vs. 0.70 (P < 0.001). This resulted in a net classification index of 0.23 (0.00–0.46, P = 0.046) and an integrated discrimination improvement of 0.12 (95% confidence interval 0.08–0.58, P = 0.02). CMR-derived regurgitant fraction (<28, 28–37, or >37%) and LV end-diastolic volume (<83, 183–236, or >236 mL) adequately stratified patients with normal EF. The agreement between techniques for grading AR severity and assessing LV dilatation was poor, and CMR showed better reproducibility. Conclusions CMR improves the clinical efficacy of ultrasound for predicting outcomes of patients with AR. This is due to its better reproducibility and accuracy for grading the severity of the disease and its impact on the LV. Regurgitant fraction, LV ejection fraction, and end-diastolic volume obtained by CMR most adequately predict AR-related events.

scholarly journals New Imaging Markers of Clinical Outcome in Asymptomatic Patients with Severe Aortic Regurgitation

2019 ◽  
Vol 8 (10) ◽  
pp. 1654
Author(s):  
Radka Kočková ◽  
Hana Línková ◽  
Zuzana Hlubocká ◽  
Alena Pravečková ◽  
Andrea Polednová ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Early Stage ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Vena Contracta ◽  
Severe Aortic Regurgitation ◽  
End Diastolic Volume ◽  
Asymptomatic Patients ◽  
Imaging Markers ◽  
And Function

Background: Determining the value of new imaging markers to predict aortic valve (AV) surgery in asymptomatic patients with severe aortic regurgitation (AR) in a prospective, observational, multicenter study. Methods: Consecutive patients with chronic severe AR were enrolled between 2015–2018. Baseline examination included echocardiography (ECHO) with 2- and 3-dimensional (2D and 3D) vena contracta area (VCA), and magnetic resonance imaging (MRI) with regurgitant volume (RV) and fraction (RF) analyzed in CoreLab. Results: The mean follow-up was 587 days (interquartile range (IQR) 296–901) in a total of 104 patients. Twenty patients underwent AV surgery. Baseline clinical and laboratory data did not differ between surgically and medically treated patients. Surgically treated patients had larger left ventricular (LV) dimension, end-diastolic volume (all p < 0.05), and the LV ejection fraction was similar. The surgical group showed higher prevalence of severe AR (70% vs. 40%, p = 0.02). Out of all imaging markers 3D VCA, MRI-derived RV and RF were identified as the strongest independent predictors of AV surgery (all p < 0.001). Conclusions: Parameters related to LV morphology and function showed moderate accuracy to identify patients in need of early AV surgery at the early stage of the disease. 3D ECHO-derived VCA and MRI-derived RV and RF showed high accuracy and excellent sensitivity to identify patients in need of early surgery.

scholarly journals Early Detection of Left Ventricular Systolic Dysfunction in Asymptomatic Patients with Chronic Aortic Regurgitation by two Dimensional Speckle Tracking Echocardiography

2019 ◽  
Vol 14 (2) ◽  
pp. 35-42
Author(s):  
Thamer I. Al-Jawahiri ◽  
Amal N. Al-Marayati,
Keyword(s):  
Early Detection ◽  
Aortic Regurgitation ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Heart Diseases ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Two Dimensional ◽  
Asymptomatic Patients ◽  
Chronic Aortic Regurgitation

Background: Early detection of subclinical left ventricular (LV) systolic dysfunction is crucial and could influence patients' prognosis by aiding the clinician to candidate patients for better management. Objective: To detect early LV systolic dysfunction in asymptomatic patient with chronic aortic regurgitation by two dimensional speckle tracking echocardiography.  Methods:  Sixty one asymptomatic patients with chronic aortic regurgitation, with no ischemic heart diseases (by coronary angiography) or conductive heart diseases, no diabetes mellitus, no hypertension, and no other valvular heart diseases (group 1) and fifty age and sex-matched healthy subjects (group 2) were enrolled into the study. Group (1) was further classified into 3 sub-groups according to 4 chosen parameters from the published guidelines of American Society of Echocardiography (ASE) into: Mild AR, Moderate AR, and Severe AR.   All patients and controls underwent echocardiographic examination including conventional echocardiography, tissue Doppler study and Two Dimensional (2-D) Speckle Tracking Echocardiography. Results: GLS showed the highest sensitivity and specificity in detection of subtle LV systolic dysfunction in moderate AR. In moderate AR,a cut off value of > (-19.62) has sensitivity and specificity of 91.3% and 95.5% respectively, with Positive Predictive Value (PPV) and Negative Predictive Value ( NPV ) of 87.5% and 96.9% respectively, Area under curve (AUC) of 0.981. In all types of AR, GLS had higher NPV than PPV which makes it a powerful screening tool for early detection of subtle LV systolic dysfunction. Conclusion: Global Longitudinal strain measured by 2-D speckle tracking echocardiography is an excellent tool for early detection of subtle LV systolic dysfunction in asymptomatic patients with chronic AR  

scholarly journals The left ventricular remodeling assessment by cardiac magnetic resonance in chronic aortic regurgitation; implications for outcome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Hashimoto ◽  
M Sarano ◽  
H Sato ◽  
B Lopes ◽  
M Fukui ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Aortic Regurgitation ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Lv Remodeling ◽  
Chronic Aortic Regurgitation

Abstract Background Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload resulting in progressive LV remodeling, which negatively affect clinical outcome. Clinical Guidelines recommend assessment of LV remodeling by echocardiography, but little is known about comparative remodeling quantification by cardiac magnetic resonance (CMR) and association with outcomes. Purpose To assess LV remodeling in AR by CMR, compared with echocardiographic measures and determine its impact on clinical outcome. Methods Patients with native, ≥moderate, chronic AR by echocardiography who underwent CMR exam within 90 days of diagnosis from January 2012 to February 2020 were enrolled. The endpoint was a composite of death, heart failure hospitalization, and heart failure symptom exacerbation during follow-up. Results The 178 patients included had median age (IQR) of 58 years (44–69), and most (88%, n=158) presented with no or minimal symptoms (NYHA class I/II). At diagnosis symptomatic vs. no/minimal symptoms patients presented with much more advanced LV remodeling by CMR (EDVI 133 [83–151] vs. 96 [80–123] p=0.024, ESVI 66 [46–85] vs. 42 [30–58], P=0.001) while echocardiography showed limited differences (EDVI 76 [57–93] vs. 65 [54–87] p=0.507, ESVI 38 [30–58] vs. 27 [20–42], p=0.072). During follow-up (3.3 years [1.6–5.8]), aortic valve replacement (AVR) was performed in 49 patients. In patients with no/minimal symptoms, the composite endpoint occurred in 54 (34%) patients including eight deaths and 30 heart failure hospitalizations. Patients with LV end-systolic volume index (LVESVi) &gt;45 ml/m2 by CMR had higher likelihood for composite endpoint (Panel A) confirmed in multivariate models, adjusting for age, sex, AVR (time-dependent), EuroSCORE2, and LV End-systolic-dimension-index (LVESDi) &gt;25 mm/2, with adjusted hazard ratio 1.84 [1.02–3.33], p&lt;0.044 (Panel B). LVESVi by CMR was at least as powerful in determining clinical outcomes as guideline-recommended Doppler-Echocardiographic variables. Conclusion Assessment of LV remodeling by CMR in patients with clinically significant AR is feasible in routine clinical practice, detects with high sensitivity LV remodeling associated with development of HF symptoms and is independently predictive of clinical outcome. Hence, CMR provides a powerful tool for evaluation and risk stratification of patients with AR. FUNDunding Acknowledgement Type of funding sources: None. Panel A Panel B

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