Functional classification of aortic regurgitation using cardiac computed tomography: comparison with surgical inspection
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In patients with aortic regurgitation (AR), a precise preoperative assessment of aortic valve (AV) pathology is important if AV repair or sparing operation is an alternative option. The aim of this study was to assess the diagnostic accuracy of computed tomography (CT) for evaluating the AR mechanism compared with surgical inspection. 59 patients with AR who underwent AV surgery and preoperative cardiac CT were evaluated. AR mechanism was classified into type 1 (aortic dilatation or cusp perforation), type 2 (prolapsed cusp) and type 3 (cusp retraction). Agreement between CT and surgical inspection was obtained. Correlation between aortic regurgitant orifice (ARO) and imaging parameters were evaluated. On surgical inspection, type 1 AR was noted in 22 patients, type 2 in 16 and type 3 in 21. Agreement regarding the AR mechanism on CT was excellent (intra-class correlation coefficient, 0.81). At the patient level, the Cohen’s κ value for CT findings with surgical inspection was of 0.89. At the cusp level, moderate agreement was noted between CT and surgical inspection. In the per-cusp analysis, CT had a sensitivity of 72.6%, specificity of 85.1%, positive predictive value of 73.8% and negative predictive value of 84.3% for the detection of aortic cusp abnormality. The diameter, perimeter and area of aortic annulus had moderate correlation with ARO (r = 0.54–0.66, P < 0.001). CT-derived classification of AR mechanism showed excellent agreement with surgical inspection.
KeywordsAortic valve Aortic regurgitation Computed tomography Aortic valve repair Aortic valve replacement
Aortic regurgitation orifice
Aortic valve replacement
Intra-class correlation coefficient
This work was supported by National Research Foundation of Korea (NRF) grants funded by the Korean government (MSIP) (NRF-2016R1A1A1A05921207 and NRF-2015R1A2A2A04003034) and by a Grant (2017-7208) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. This work was also funded by the Industrial Strategic technology development program (10072064) of the Ministry of Trade Industry and Energy of Korea. The content of this study is solely the responsibility of the authors and does not represent the official views of the funding sources, and the funding sources had no involvement in this study.
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Conflict of interest
The authors declare that they have no competing interests.
The authors have no relationships relevant to the contents of this paper to disclose.
- 2.de Kerchove L, Boodhwani M, Glineur D, Poncelet A, Rubay J, Watremez C, Vanoverschelde JL, Noirhomme P, El Khoury G (2009) Cusp prolapse repair in trileaflet aortic valves: free margin plication and free margin resuspension techniques. Ann Thorac Surg 88:455–461 (discussion 461)CrossRefPubMedGoogle Scholar
- 13.le Polain de Waroux JB, Pouleur AC, Goffinet C, Vancraeynest D, Van Dyck M, Robert A, Gerber BL, Pasquet A, El Khoury G, Vanoverschelde JL (2007) Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation 116:I264–I269CrossRefPubMedGoogle Scholar
- 16.Kim DH, Handschumacher MD, Levine RA, Sun BJ, Jang JY, Yang DH, Kang JW, Song JM, Kang DH, Lim TH, Song JK (2014) Aortic valve adaptation to aortic root dilatation: insights into the mechanism of functional aortic regurgitation from 3-dimensional cardiac computed tomography. Circ Cardiovasc Imaging 7:828–835CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Kang JW, Song HG, Yang DH, Baek S, Kim DH, Song JM, Kang DH, Lim TH, Song JK (2013) Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography. JACC Cardiovasc Imaging 6:150–161CrossRefPubMedGoogle Scholar
- 21.Tsai IC, Choi BW, Chan C, Jinzaki M, Kitagawa K, Yong HS, Yu W (2010) ASCI 2010 appropriateness criteria for cardiac computed tomography: a report of the Asian Society of Cardiovascular Imaging Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging Guideline Working Group. Int J Cardiovasc Imaging 26(Suppl 1):1–15CrossRefPubMedGoogle Scholar
- 22.Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 70:252–289CrossRefPubMedGoogle Scholar