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

Alena Pravečková,Hana Línková,Radka Kočková,Jaroslav Hlubocký,Gabriela Dostálová,Martin Pěnička,Zuzana Hlubocká,Aleš Linhart,Martin Bláha

doi:10.3390/jcm11010152

Abstract

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.

Highlights

All patients were asymptomatic with preserved left ventricular (LV) systolic function and sinus rhythm
To predict severe aortic regurgitation (AR) by cardiac magnetic resonance (CMR) regurgitant volume (RV) was observed for diastolic flow reversal (DFR) velocity in the descending aorta (AUC = 0.79) and 3D vena contracta area (VCA) (AUC = 0.73)
In a cohort of asymptomatic patients with moderate-to-severe and severe aortic regurgitation, we found DFR velocity in descending aorta and 3D VCA to be most closely correlated with the quantitative measures of AR severity (RF and RV) determined by CMR

Summary

Introduction

Management of asymptomatic patients with chronic severe aortic regurgitation (AR). Reliable quantification of AR severity is of crucial importance for guiding clinical management and improving clinical outcome [1,2]. Such patients typically remain asymptomatic for a long time, they should be promptly referred to surgery once either symptoms or LV dysfunction develop [3–5]. Transthoracic echocardiography is recognized as the primary imaging modality for initial assessment and longitudinal evaluation of patients with chronic AR. Three-dimensional echocardiography provides more precise assessment of LV volumes and function. 3D color Doppler echocardiography measures the 3D vena contracta area (VCA) and proximal isovelocity surface area (PISA) and may increase accuracy of AR quantification [7,8]

Objectives

Methods

Results

Discussion

Conclusion