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Holodiastolic Flow Reversal at the Descending Aorta on Cardiac Magnetic Resonance is Neither Sensitive Nor Specific for Significant Aortic Regurgitation in Patients with Congenital Heart Disease

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Abstract

Holodiastolic flow reversal in the descending aorta on echocardiogram suggests significant aortic regurgitation. The study aim was to determine whether the presence of holodiastolic flow reversal on cardiac magnetic resonance imaging (MRI) correlates with aortic valve regurgitant fraction. We retrospectively reviewed 166 cardiac MRIs (64 % male, age 14.1 ± 9.5 years) from January 2011 to May 2012 where velocity mapping was acquired at both the aortic valve and the descending aorta at the level of the diaphragm. Descending aorta velocity maps were checked for baseline offset using a static reference region. Holodiastolic flow reversal was defined as flow reversal throughout diastole both before and after baseline correction. Significant aortic regurgitation was defined as regurgitant fraction >10 %. Aortic valve regurgitant fraction was <10 % in 144 patients (Group A), 10–20 % inclusive in 7 patients (Group B), and >20 % in 15 patients (Group C). Though the aortic valve regurgitant fraction was significantly higher for patients with holodiastolic flow reversal versus those without (8.5 ± 14.2 vs. 3.8 ± 6.6 %, p = 0.02), holodiastolic flow reversal was present in 32 Group A patients (22 %). In comparison, 4 Group B patients (57 %) and 7 Group C patients (47 %) had holodiastolic flow reversal. The sensitivity (Groups B and C) was 0.5, and the specificity (Group A) was 0.78. Holodiastolic flow reversal in the descending aorta on cardiac MRI was neither sensitive nor specific for predicting significant aortic regurgitation in this study population. Holodiastolic flow reversal in the absence of significant aortic regurgitation may be a relatively common finding in patients with congenital heart disease.

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This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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    Authors and Affiliations

    1. Division of Cardiology, St. Christopher’s Hospital for Children, 160 East Erie Avenue, Philadelphia, PA, 19134, USA

      Catherine M. Avitabile

    2. Division of Cardiology, The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA

      Catherine M. Avitabile, Kevin K. Whitehead, Mark A. Fogel, Daniel W. Kim, Timothy S. Kim, Julian D. Rose, Gregory L. Fu & Matthew A. Harris

    3. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA

      Kevin K. Whitehead, Mark A. Fogel, Marc S. Keller & Matthew A. Harris

    4. Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA

      Kevin K. Whitehead, Mark A. Fogel, Marc S. Keller & Matthew A. Harris

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    1. Catherine M. Avitabile
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    2. Kevin K. Whitehead
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    Correspondence to Catherine M. Avitabile.

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    Catherine M. Avitabile and Kevin K. Whitehead have contributed equally to this work.

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    Avitabile, C.M., Whitehead, K.K., Fogel, M.A. et al. Holodiastolic Flow Reversal at the Descending Aorta on Cardiac Magnetic Resonance is Neither Sensitive Nor Specific for Significant Aortic Regurgitation in Patients with Congenital Heart Disease. Pediatr Cardiol 37, 1284–1289 (2016). https://doi.org/10.1007/s00246-016-1430-7

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    • DOI: https://doi.org/10.1007/s00246-016-1430-7

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