Aortic regurgitation and left ventricle remodeling on cardiac magnetic resonance and transthoracic echocardiography
Abstract
Background: Transthoracic echocardiography (TTE) is the first imaging modality used to assess aortic regurgitation (AR). However, it is not possible to provide precise quantification in all patients.
Aim: Our aim was to compare TTE and cardiovascular magnetic resonance (CMR) measurements in grading AR and left ventricle (LV) remodeling.
Methods: A total of 51 consecutive patients with AR in TTE (New York Heart Association I/II, 55%/38%) were enrolled into the study and 49 individuals (age, 57.1 [14]; 61% males) underwent a non-contrast CMR (2 patients excluded) obtained on 1.5 T system (GE Optima MR450w).
Results: The comprehensive quantitative grading with AR volume (AR vol) and regurgitant fraction (RF) were measurable in TTE in 24 cases and showed an association with CMR parameters (AR vol: r = 0.75; P <0.001 and RF: r = 0.55; P <0.01). CMR revealed larger LV end-diastolic volumes (EDV) (185.5 [61] vs 158.4 [61] ml; P = 0.03) and a trend towards higher left ventricular ejection fraction (59% [8] vs 56% [8]; P = 0.08). The association of AR vol and LV EDV was stronger in CMR (r = 0.85; P <0.0001) compared to TTE (r = 0.6; P = 0.001). The inter-modality agreement (TTE-CMR) in AR grading was low (κ = 0.15), with highly concordant grading in mild AR (91%).
Conclusions: CMR provides a comprehensive assessment of AR severity and LV remodeling with a weak or a moderate agreement with TTE.
Keywords: aortic regurgitationcardiovascular magnetic resonanceechocardiography
References
- Baumgartner H, Falk V, Bax JJ. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38(36): 2739–2791.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
- Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation – a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017; 30(4): 303–371.
- Myerson SG, d'Arcy J, Mohiaddin R, et al. Aortic regurgitation quantification using cardiovascular magnetic resonance: association with clinical outcome. Circulation. 2012; 126(12): 1452–1460.
- Medvedofsky D, León Jiménez J, Addetia K, et al. Multi-parametric quantification of tricuspid regurgitation using cardiovascular magnetic resonance: A comparison to echocardiography. Eur J Radiol. 2017; 86: 213–220.
- Sköldborg V, Madsen PL, Dalsgaard M, et al. Quantification of mitral valve regurgitation by 2D and 3D echocardiography compared with cardiac magnetic resonance a systematic review and meta-analysis. Int J Cardiovasc Imaging. 2020; 36(2): 279–289.
- Pirat B, Little SH, Igo SR, et al. Direct measurement of proximal isovelocity surface area by real-time three-dimensional color Doppler for quantitation of aortic regurgitant volume: an in vitro validation. J Am Soc Echocardiogr. 2009; 22(3): 306–313.
- Cawley PJ, Hamilton-Craig C, Owens DS, et al. Prospective comparison of valve regurgitation quantitation by cardiac magnetic resonance imaging and transthoracic echocardiography. Circ Cardiovasc Imaging. 2013; 6(1): 48–57.
- Gelfand EV, Hughes S, Hauser TH, et al. Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography. J Cardiovasc Magn Reson. 2006; 8(3): 503–507.
- Lee JC, Branch KR, Hamilton-Craig C, et al. Evaluation of aortic regurgitation with cardiac magnetic resonance imaging: a systematic review. Heart. 2018; 104(2): 103–110.
- Neisius U, Tsao CW, Hauser TH, et al. Aortic regurgitation assessment by cardiovascular magnetic resonance imaging and transthoracic echocardiography: intermodality disagreement impacting on prediction of post-surgical left ventricular remodeling. Int J Cardiovasc Imaging. 2020; 36(1): 91–100.
- Harris AW, Krieger EV, Kim M, et al. Cardiac Magnetic Resonance Imaging Versus Transthoracic Echocardiography for Prediction of Outcomes in Chronic Aortic or Mitral Regurgitation. Am J Cardiol. 2017; 119(7): 1074–1081.
- Gabriel RS, Renapurkar R, Bolen MA, et al. Comparison of severity of aortic regurgitation by cardiovascular magnetic resonance versus transthoracic echocardiography. Am J Cardiol. 2011; 108(7): 1014–1020.
- Kutty S, Whitehead KK, Natarajan S, et al. Qualitative echocardiographic assessment of aortic valve regurgitation with quantitative cardiac magnetic resonance: a comparative study. Pediatr Cardiol. 2009; 30(7): 971–977.
- Dulce MC, Mostbeck GH, O'Sullivan M, et al. Severity of aortic regurgitation: interstudy reproducibility of measurements with velocity-encoded cine MR imaging. Radiology. 1992; 185(1): 235–240.
- Honda N, Machida K, Hashimoto M, et al. Aortic regurgitation: quantitation with MR imaging velocity mapping. Radiology. 1993; 186(1): 189–194.
- Søndergaard L, Hildebrandt P, Lindvig K, et al. Quantification of aortic regurgitation by magnetic resonance velocity mapping. Am Heart J. 1993; 125(4): 1081–1090.
- Bellenger NG, Burgess MI, Ray SG, et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J. 2000; 21(16): 1387–1396.
- Hudsmith LE, Petersen SE, Francis JM, et al. Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. J Cardiovasc Magn Reson. 2005; 7(5): 775–782.
- Uretsky S, Supariwala A, Nidadovolu P, et al. Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation. J Cardiovasc Magn Reson. 2010; 12: 32.
- Gocoł R, Malinowski M, Bis J, et al. Long-term outcomes of aortic valve repair in over 500 consecutive patients: a single-center experience. Kardiol Pol. 2020; 78(9): 861–868.
- Łukaszewski M, Bielicki G, Berezowski M, et al. Aortic valve-sparing procedures in patients with aortic valve insufficiency: a single‑center experience. Kardiol Pol. 2020; 78(2): 158–160.
