Aortic regurgitation assessment by cardiovascular magnetic resonance imaging and transthoracic echocardiography: intermodality disagreement impacting on prediction of post-surgical left ventricular remodeling

  • Ulf Neisius
  • Connie W. Tsao
  • Thomas H. Hauser
  • Apranta D. Patel
  • Patrick Pierce
  • Eyal Ben-Assa
  • Reza Nezafat
  • Warren J. ManningEmail author
Original Paper


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.


Aortic regurgitation Aortic valve surgery Observer variation Remodeling Magnetic resonance imaging Transthoracic echocardiography 



Aortic regurgitation


American Society of Echocardiography


Aortic valve replacement


Cardiovascular magnetic resonance


Change of LVEDD


Change of LVEDV


Change of LVESV


Intraclass correlation coefficient


Left ventricle/left ventricular


LV end-diastolic diameter


LV end-diastolic volume


LV end-systolic diameter


LV end-systolic volume


Right ventricle/right ventricular


Transthoracic echocardiography


Society for Cardiovascular Magnetic Resonance



The authors thank Beth Goddu, RT(MR) and Sophie Berg, RN for their help with CMR scanning and patient management.

Compliance with ethical standards

Conflict of interest

No conflicts of interest, financial or otherwise, are declared by the authors.

Supplementary material

10554_2019_1682_MOESM1_ESM.docx (20 kb)
Supplementary file1 (DOCX 20 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Medicine (Cardiovascular Division), Harvard Medical SchoolBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Institute of Medical Engineering and ScienceMassachusetts Institute of TechnologyCambridgeUSA
  3. 3.Department of Radiology, Harvard Medical SchoolBeth Israel Deaconess Medical CenterBostonUSA

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