1051 Assessment of asymptomatic severe aortic regurgitation by doppler-derived echo indices: comparison with magnetic resonance quantification

Abstract Funding Acknowledgements This study was supported by Ministry of Health of the Czech Republic 17-28265A Introduction Management of asymptomatic patients with chronic severe aortic regurgitation (AR) is challenging. Reliable quantification of the AR severity is essential. Transthoracic echocardiography (TTE) is a primary imaging modality. Grading of AR severity is achieved by an integrative approach. Cardiovascular magnetic resonance (CMR) can directly quantify AR severity by measuring regurgitation volume (RV) and regurgitation fraction (RF). Purpose There are few data on direct comparison between TTE and CMR for quantification of AR. Our study aimed to compare quantitative and indirect echo-Doppler indices to quantitative MRI derived parameters in asymptomatic patients with severe chronic AR. Methods In a prospective three-centre study, we evaluated patients with moderate to severe (3+) and severe (4+) chronic AR using TTE and CMR. All patients were asymptomatic, without indication for surgical treatment. The severity of AR was graded using TTE multiparametric approach. A 2-D and 3-D TTE were performed with an assessment of left ventricle size and function, valve morphology, Doppler parameters of AR including vena contracta width, diastolic flow reversal velocity in descending aorta, RV, RF using volumetric method, 3D-vena contracta area (3D-VCA). The CMR quantified left ventricle volumes and function, RF and RV using the phase-contrast velocity mapping. All imaging studies were analysed in CoreLab. Results A total of 104 patients were enrolled during 2015-2018. Mean patient age was 44 ± 13 years, 89 patients (86%) were males and 83 patients (81%) had a bicuspid or unicuspid aortic valve. Using the TTE severe (4+) AR was present in 48 (46%) and moderate to severe (3+) AR in 56 (54%) individuals. Concordant grading of AR severity with both techniques was observed in 77 (74%) patients. An integrative TTE approach showed a trend to underestimate AR severity. The best correlation between echo-Doppler indices and CMR measured RV and RF was found in two parameters: diastolic flow reversal velocity in descending aorta ( Rs = 0,62, p < 0,0001 for RV, Rs = 0,50, p < 0,0001 for RF) and 3D-VCA (Rs = 0,48 for RV, p < 0,0001 , Rs = 0,38 for RF, p < 0,0001). On the contrary vena contracta width showed poor correlation with CMR (Rs = 0,18, p = 0,07 for RV and Rs = 0,11, p = 0,29 for RF). Correlation between quantitative parameters of AR assessed by TTE volumetric method and CMR technique was modest (Rs = 0,40 for RF and Rs = 0,50 for RV, p < 0,0001), 95% confidence intervals were wide. Good correlation between TTE and CMR were found for LV dimensions, volumes and ejection fraction. Conclusion Out of indirect Doppler-echo indices of AR severity, diastolic flow reversal velocity in descending aorta and 3D-vena contracta area showed the best correlation with MRI derived RF and RV in patients with chronic severe AR. Quantitative parameters of AR (RF and RV) assessed by echo volumetric method had an only modest correlation to RF and RV measured using CMR.

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Assessment of Asymptomatic Severe Aortic Regurgitation by Doppler-Derived Echo Indices: Comparison with Magnetic Resonance Quantification

Journal of Clinical Medicine ◽

10.3390/jcm11010152 ◽

2021 ◽

Vol 11 (1) ◽

pp. 152

Author(s):

Zuzana Hlubocká ◽

Radka Kočková ◽

Hana Línková ◽

Alena Pravečková ◽

Jaroslav Hlubocký ◽

...

Keyword(s):

Magnetic Resonance ◽

Aortic Regurgitation ◽

Mapping Technique ◽

Velocity Mapping ◽

Characteristic Analysis ◽

Descending Aorta ◽

Vena Contracta ◽

Severe Aortic Regurgitation ◽

Doppler Indices ◽

Vena Contracta Area

Reliable quantification of aortic regurgitation (AR) severity is essential for clinical management. We aimed to compare quantitative and indirect echo-Doppler indices to quantitative cardiac magnetic resonance (CMR) parameters in asymptomatic chronic severe AR. Methods and Results: We evaluated 104 consecutive patients using echocardiography and CMR. A comprehensive 2D, 3D, and Doppler echocardiography was performed. The CMR was used to quantify regurgitation fraction (RF) and volume (RV) using the phase-contrast velocity mapping technique. Concordant grading of AR severity with both techniques was observed in 77 (74%) patients. Correlation between RV and RF as assessed by echocardiography and CMR was relatively good (rs = 0.50 for RV, rs = 0.40 for RF, p < 0.0001). The best correlation between indirect echo-Doppler and CMR parameters was found for diastolic flow reversal (DFR) velocity in descending aorta (rs = 0.62 for RV, rs = 0.50 for RF, p < 0.0001) and 3D vena contracta area (VCA) (rs = 0.48 for RV, rs = 0.38 for RF, p < 0.0001). Using receiver operating characteristic analysis, the largest area under curve (AUC) to predict severe AR by CMR RV was observed for DFR velocity (AUC = 0.79). DFR velocity of 19.5 cm/s provided 78% sensitivity and 80% specificity. The AUC for 3D VCA to predict severe AR by CMR RV was 0.73, with optimal cut-off of 26 mm2 (sensitivity 80% and specificity 66%). Conclusions: Out of the indirect echo-Doppler indices of AR severity, DFR velocity in descending aorta and 3D vena contracta area showed the best correlation with CMR-derived RV and RF in patients with chronic severe AR.

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

Journal of Clinical Medicine ◽

10.3390/jcm8101654 ◽

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.

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P910 Can left ventricular volume and diastolic flow reversal in descending aorta be useful to rule in or rule out severe chronic aortic regurgitation?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.547 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S A Gao ◽

C L Polte ◽

K M Lagerstrand ◽

O Bech-Hanssen

Keyword(s):

Aortic Regurgitation ◽

Test Group ◽

Left Ventricular ◽

Flow Reversal ◽

Volume Index ◽

Descending Aorta ◽

Diastolic Flow ◽

Quantitative Parameters ◽

Chronic Aortic Regurgitation ◽

Rule Out

Abstract Funding Acknowledgements The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF¬-agreement Background and Purpose Grading severity of chronic aortic regurgitation (AR) by echocardiography may be challenging in cases with few feasible parameters leading to diagnostic uncertainty. The aim of the present study was to transform left ventricular (LV) volume and diastolic flow reversal to quantitative parameters using cardiovascular magnetic resonance (CMR) as reference. Methods Patients (n = 120) were recruited either prospectively (n= 45, CMR performed < 4 hours) or retrospectively (n = 75, CMR performed < 21 days (median)). The latter comprised patients with echocardiographic uncertainty. LV end-diastolic volume index (LVEDVI) by Simpson biplane method and end-diastolic flow velocity (EDFV) in the proximal descending aorta were assessed. The patients were randomised to either a derivation (n = 60) or a test group (n = 60). Results Severe AR (regurgitant fraction by CMR > 33%) was present in 51% of the patients. In the derivation group, the area under the ROC curves for LVEDVI was 0.80 (95% CI 0.67-0.93) and for EDFV was 0.83 (95% CI 0.71-0.94). LVEDVI > 99 ml/m2 and ≤ 75 ml/m2 were useful to rule in and rule out severe AR, respectively. The corresponding for EDFV were > 17 cm/s and ≤ 10 cm/s. The diagnostic performances of the cut off values in the test group are presented in the Table. Conclusions LVEDVI and EDFV are useful quantitative parameters to rule in and rule out severe chronic AR in patients with diagnostic ambiguity. Combination of LVEDVI > 99 ml/m2 and EDFV > 17 cm/s is the most useful to rule in severe AR. Sensitivity (%) (95% CI) Specificity (%) (95% CI) Positive likelihood ratio (95% CI) Negative likelihood ration (95% CI) Rule in severe AR LVEDVI (> 99 ml/ m2) 48 (29-67) 95 (77-99) 10.0 (1.4-71) 0.55 (0.37-0.82) Rule out severe AR LVEDVI (≤ 75 ml/m2) 91 (73-98) 62 (41-79) 2.4 (1.4-4.2) 0.14 (0.04-0.55) Rule in severe AR EDFV (> 17 cm/s) 44 (28-63) 96 (79-99) 10.2 (1.4-73) 0.58 (0.41-0.82) Rule out severe AR EDFV (≤ 10 cm/s) 96 (82-99) 48 (29-67) 1.9 (1.2-2.8) 0.08 (0.01-0.56) Rule in severe AR > 99 ml/m2 + > 17 cm/s 36 (20-57) 100 (82-100) - 0.64 (0.46-0.87) Rule out severe AR ≤ 75 ml/m2 + ≤ 10 cm/s 91 (72-98) 29 (13-53) 1.3 (0.92-1.8) 0.31 (0.07-1.4)

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Pulmonary Venous Diastolic Flow Reversal in Severe Aortic Regurgitation

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2011.03.012 ◽

2012 ◽

Vol 26 (2) ◽

pp. 283-285

Author(s):

Stefaan Bouchez ◽

Thierry Bove ◽

Patrick F. Wouters

Keyword(s):

Aortic Regurgitation ◽

Flow Reversal ◽

Severe Aortic Regurgitation ◽

Diastolic Flow

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Abstract 17131: Diastolic Dysfunction in Asymptomatic Patients With Moderate to Severe Aortic Regurgitation is Strongly Related to Increased Longitudinal Fiber Stress and Subsequent Non-uniform Myocardial Relaxation

Circulation ◽

10.1161/circ.130.suppl_2.17131 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Stig Urheim ◽

Kaspar Broch ◽

Gabor Kunszt ◽

Richard Massey ◽

Svend Aakhus ◽

...

Keyword(s):

Strain Rate ◽

Diastolic Dysfunction ◽

Aortic Regurgitation ◽

Flow Rate ◽

Time Derivative ◽

Fiber Stress ◽

Severe Aortic Regurgitation ◽

Diastolic Flow ◽

Asymptomatic Patients ◽

Longitudinal Fiber

Introduction: Diastolic dysfunction in aortic regurgitation (AR) is present at an early stage of the disease. Yet, the mechanisms are not clearly understood. Hypothesis: We hypothesized that diastolic dysfunction in AR patients is caused by increased longitudinal (meridional) fiber stress and subsequent impaired relaxation of the corresponding subendocardial (longitudinal) fibers. Methods: Thirty asymptomatic patients with moderate to severe aortic regurgitation (AR) and 17 age matched healthy controls (C) where analyzed (32 ± 7 and 35 ± 4 (SD) years, respectively, p=NS) with 3D speckle tracking echocardiography. We measured early diastolic longitudinal- (LSRe) and circumferential (CSRe) strain rate (1/s) as the time derivative of strain (%) and the peak difference (LSRe – CSRe) during isovolumic relaxation (IVR). Early diastolic flow rate (sec -1 ) was estimated as the time derivative of the LV volume curve normalized to end-diastolic volume (EDV). Finally, we calculated end-systolic meridional fiber stress (mmHg). Results: LV ejection fraction in C and AR was 61 ± 2 and 62 ± 3 %, respectively (p=NS). AR patients had signs of impaired LV filling with lower early diastolic flow rate (Table 1). During IVR, the strain rate curves consistently departed (Figure 1, arrow), indicating a non-homogenous relaxation. A negative correlation was shown between meridional fiber stress and the IVR strain rate gradient (y= -0.0123x + 1.0921, r=0.61, p<0.001). Conclusions: We have demonstrated a non-homogenous relaxation of subendocardial- relative to circumferential fibers in AR patients that strongly correlated with longitudinal fiber stress, suggesting a causal relationship.

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Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

Author(s):

Westhoff-Bleck ◽

Meyer ◽

Lotz ◽

Tutarel ◽

Weiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Root ◽

Ascending Aorta ◽

Descending Aorta ◽

Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

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