Use of cardiac magnetic resonance imaging and cardiac magnetic resonance feature-tracking strain analysis to characterize and differentiate aortic annular strain patterns in aortic valve regurgitation versus normal aortic valves.

Abstract

Understanding the aortic annulus is important for obtaining reproducible and durable aortic valve (AV) repair and allowing advances for transcatheter AV replacement treatment of aortic regurgitation (AR). Significant limitations exist when using echocardiography and computed tomography-based imaging with feature tracking at the aortic annulus. Cardiac magnetic resonance is used to obtain regional longitudinal strain and can be modified to obtain circumferential annular strain at the fibrous and muscular portions of the AV annulus. Holst et al. use a novel method to characterize and prove that adverse annular deformation occurs at the muscular portion of the AV annulus in patients with AR. In their study, cardiovascular magnetic resonance (CMR) imaging and CMR feature-tracking strain analysis are used to characterize aortic annular regional longitudinal strain (RLS) in humans. The authors convincing show that the direction of muscular annular deformation in patients with AR is opposite to the direction of muscular annular deformation in patients with normal Avs, (median RLS: 4.18% in patients with severe AR vs. -10.41% in well-functioning AVs, p = .024; at RLS muscular annulus). The direction of muscular annular deformation in patients with AR is opposite to the direction of muscular annular deformation in patients with normal AVs. This information will have impactful physiological relevance for surgical and percutaneous treatment of aortic valve pathology.