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

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Abstract

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.

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Abbreviations

AR:

Aortic regurgitation

ASE:

American Society of Echocardiography

AVR:

Aortic valve replacement

CMR:

Cardiovascular magnetic resonance

ΔLVEDD:

Change of LVEDD

ΔLVEDV:

Change of LVEDV

ΔLVESV:

Change of LVESV

ICC:

Intraclass correlation coefficient

LV:

Left ventricle/left ventricular

LVEDD:

LV end-diastolic diameter

LVEDV:

LV end-diastolic volume

LVESD:

LV end-systolic diameter

LVESV:

LV end-systolic volume

RV:

Right ventricle/right ventricular

TTE:

Transthoracic echocardiography

SCMR:

Society for Cardiovascular Magnetic Resonance

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Medicine (Cardiovascular Division), Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA

    Ulf Neisius, Connie W. Tsao, Thomas H. Hauser, Apranta D. Patel, Patrick Pierce, Eyal Ben-Assa, Reza Nezafat & Warren J. Manning

  2. Institute of Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, USA

    Eyal Ben-Assa

  3. Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA

    Warren J. Manning

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  1. Ulf Neisius
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Neisius, U., Tsao, C., Hauser, T.H. et al. Aortic regurgitation assessment by cardiovascular magnetic resonance imaging and transthoracic echocardiography: intermodality disagreement impacting on prediction of post-surgical left ventricular remodeling. Int J Cardiovasc Imaging 36, 91–100 (2020). https://doi.org/10.1007/s10554-019-01682-x

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