Functional classification of aortic regurgitation using cardiac computed tomography: comparison with surgical inspection
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.
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