Aortic regurgitation assessment by cardiovascular magnetic resonance imaging and transthoracic echocardiography: intermodality disagreement impacting on prediction of post-surgical left ventricular remodeling.
Ulf NeisiusConnie W TsaoThomas H HauserApranta D PatelPatrick PierceEyal Ben-AssaReza NezafatWarren J ManningPublished in: The international journal of cardiovascular imaging (2019)
Transthoracic echocardiography (TTE) is the primary clinical imaging modality for the assessment of patients with isolated aortic regurgitation (AR) in whom TTE's linear left ventricular (LV) dimension is used to assess disease severity to guide aortic valve replacement (AVR), yet TTE is relatively limited with regards to its integrated semi-quantitative/qualitative approach. We therefore compared TTE and cardiovascular magnetic resonance (CMR) assessment of isolated AR and investigated each modality's ability to predict LV remodeling after AVR. AR severity grading by CMR and TTE were compared in 101 consecutive patients referred for CMR assessment of chronic AR. LV end-diastolic diameter and end-systolic diameter measurements by both modalities were compared. Twenty-four patients subsequently had isolated AVR. The pre-AVR estimates of regurgitation severity by CMR and TTE were correlated with favorable post-AVR LV remodeling. AR severity grade agreement between CMR and TTE was moderate (ρ = 0.317, P = 0.001). TTE underestimated CMR LV end-diastolic and LV end-systolic diameter by 6.6 mm (P < 0.001, CI 5.8-7.7) and 5.9 mm (P < 0.001, CI 4.1-7.6), respectively. The correlation of post-AVR LV remodeling with CMR AR grade (ρ = 0.578, P = 0.004) and AR volumes (R = 0.664, P < 0.001) was stronger in comparison to TTE (ρ = 0.511, P = 0.011; R = 0.318, P = 0.2). In chronic AR, CMR provides more prognostic relevant information than TTE in assessing AR severity. CMR should be considered in the management of chronic AR patients being considered for AVR.
Keyphrases
- left ventricular
- aortic stenosis
- ejection fraction
- aortic valve
- aortic valve replacement
- blood pressure
- magnetic resonance imaging
- end stage renal disease
- magnetic resonance
- heart failure
- newly diagnosed
- cardiac resynchronization therapy
- hypertrophic cardiomyopathy
- mitral valve
- computed tomography
- transcatheter aortic valve implantation
- healthcare
- systematic review
- photodynamic therapy
- prognostic factors
- coronary artery disease
- atrial fibrillation
- optic nerve
- patient reported outcomes
- acute coronary syndrome
- percutaneous coronary intervention
- atomic force microscopy