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.

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

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Z Hlubocka ◽  
H Linkova ◽  
A Praveckova ◽  
A Polednova ◽  
G Dostalova ◽  
...  
Keyword(s):  
Volumetric Method ◽  
Flow Reversal ◽  
Descending Aorta ◽  
Vena Contracta ◽  
Severe Aortic Regurgitation ◽  
Diastolic Flow ◽  
Asymptomatic Patients ◽  
Doppler Indices ◽  
And Function ◽  
Vena Contracta Area

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 &lt; 0,0001 for RV, Rs = 0,50, p &lt; 0,0001 for RF) and 3D-VCA (Rs = 0,48 for RV, p &lt; 0,0001 , Rs = 0,38 for RF, p &lt; 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 &lt; 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.

Dimensional analysis of the left ventricle: effects of acute aortic regurgitation

1975 ◽  
Vol 228 (2) ◽  
pp. 536-542 ◽  
Author(s):  
SJ Leshin ◽  
LD Horwitz ◽  
JH Mitchell
Keyword(s):  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Severe Aortic Regurgitation ◽  
End Diastolic Volume ◽  
Catheter Technique ◽  
End Systolic Volume

The effects of acute severe aortic regurgitation on the left ventricle were investigated in conscious, chronically instrumented dogs. Left ventricular dimensions and volumes were measured from biplane cineradiographs of beads positioned near the endocardium. Data were collected before and after the production of aortic regurgitation by a catheter technique. The aortic regurgitation resulted in increases in mean aortic pulse pressure from 44 to 73 mmHg (P smaller than 0.001), heart rate from 87 to 122 beats/min (P smaller than 0.02), and left ventricular end-diastolic pressure from 11 to 25 mmHg (P smaller than 0.05). Mean end-diastolic volume rose from 61 to 69 cc (P smaller than 0.001), while end-systolic volume remained unchanged at 37 cc. The end-diastolic dilatation following regurgitation was asymmetrical in that the increase in size was due principally to an increase in the septal-lateral axis. The acute volume load of aortic regurgitation was accomplished by an increase in end-diastolic volume, i.e., the Frank-Starling mechanism. The tachycardia probably reflects augmented cardiac sympathetic activity, but the constant end-systolic volume at a similar mean systolic pressure suggests that the net contractile state was unchanged.

scholarly journals Left ventricular contraction pattern in asymptomatic patients with moderate to severe aortic regurgitation

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P621-P621
Author(s):  
S. Urheim ◽  
K. Broch ◽  
R. Massey ◽  
S. De Marchi ◽  
S. Aakhus ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Left Ventricular ◽  
Ventricular Contraction ◽  
Contraction Pattern ◽  
Severe Aortic Regurgitation ◽  
Asymptomatic Patients

scholarly journals Reduced left ventricular contractility, increased diastolic operant stiffness and high energetic expenditure in patients with severe aortic regurgitation without indication for surgery

2020 ◽  
Vol 32 (1) ◽  
pp. 29-38
Author(s):  
Jan-Christian Reil ◽  
Gert-Hinrich Reil ◽  
Nora Hecker ◽  
Vasco Sequeira ◽  
Jeffrey S. Borer ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Stroke Work ◽  
Ventricular Contractility ◽  
Indication For Surgery ◽  
Severe Aortic Regurgitation ◽  
End Diastolic Volume ◽  
Systolic And Diastolic Function ◽  
Mild Hypertensive

Abstract OBJECTIVES Recent mortality studies showed worse prognosis in patients (ARNS) with severe aortic regurgitation and preserved ejection fraction (EF) not fulfilling the criteria of current guidelines for surgery. The aim of our study was to analyse left ventricular (LV) systolic and diastolic function and mechanical energetics to find haemodynamic explanations for the reduced prognosis of these patients and to seek a new concept for surgery. METHODS Global longitudinal strain (GLS) and echo-based single-beat pressure–volume analyses were performed in patients with ARNS (LV end-diastolic diameter &lt;70 mm, EF &gt;50%, GLS &gt; −19% n = 41), with indication for surgery (ARS; n = 19) and in mild hypertensive controls (C; n = 20). Additionally, end-systolic elastance (LV contractility), stroke work and total energy (pressure–volume area) were calculated. RESULTS ARNS demonstrated significantly depressed LV contractility versus C: end-systolic elastance (1.58 ± 0.7 vs 2.54 ± 0.8 mmHg/ml; P &lt; 0.001), despite identical EF (EF: 59 ± 6% vs 59 ± 7%). Accordingly, GLS was decreased [−15.7 ± 2.7% (n = 31) vs −21.2 ± 2.4%; P &lt; 0.001], end-diastolic volume (236 ± 90 vs 136 ± 30 ml; P &lt; 0.001) and diastolic operant stiffness were markedly enlarged, as were pressure–volume area and stroke work, indicating waste of energy. The correlation of GLS versus end-systolic elastance was good (r = −0.66; P &lt; 0.001). ARNS and ARS patients demonstrated similar haemodynamic disorders, whereas only GLS was worse in ARS. CONCLUSIONS ARNS patients almost matched the ARS patients in their haemodynamic and energetic deterioration, thereby explaining poor prognosis reported in literature. GLS has been shown to be a reliable surrogate for LV contractility, possibly overestimating contractility due to exhausted preload reserve in aortic regurgitation patients. GLS may outperform conventional echo parameters to predict more precisely the timing of surgery.

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 &lt; 0.0001), and C-index = 0.80 vs. 0.70 (P &lt; 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 (&lt;28, 28–37, or &gt;37%) and LV end-diastolic volume (&lt;83, 183–236, or &gt;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.

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