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Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Aortic Regurgitation

  • Cardiac PET, CT, and MRI (P Cremer, Section Editor)
  • Published:
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Abstract

Purpose of Review

Cardiac magnetic resonance (CMR) is emerging as a valuable imaging modality for the assessment of aortic regurgitation (AR). In this review, we discuss the assessment of AR severity, left ventricular (LV) remodeling, and tissue characterization by CMR while highlighting the latest studies and addressing future research needs.

Recent Findings

Recent studies have further established CMR-based thresholds of AR severity and LV remodeling that are associated with adverse clinical outcomes, and lower than current guideline criteria. In addition, tissue profiling with late gadolinium enhancement (LGE) and extracellular volume (ECV) quantification can reliably assess adverse myocardial tissue remodeling which is also associated with adverse outcomes.

Summary

The strengths and reproducibility of CMR in evaluating ventricular volumes, tissue characteristics, and regurgitation severity position it as an excellent modality in evaluating and following AR patients. Advanced CMR techniques for the detection of tissue remodeling have shown significant potential and merit further investigation.

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Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

AR:

Aortic regurgitation

TTE:

Transthoracic echocardiography

CMR:

Cardiac magnetic resonance

PC:

Phase contrast

LGE:

Late gadolinium enhancement

ACC/AHA:

American College of Cardiology/American Heart Association

RVol:

Regurgitant volume

RF:

Regurgitant fraction

LVSV:

Left ventricular stroke volume

LVESV:

Left ventricular end-systolic volume

LVEDV:

Left ventricular end-diastolic volume

LVESD:

Left ventricular end-systolic diameter

LVEDD:

Left ventricular end-diastolic diameter

iECV:

Indexed extracellular volume

HDR:

Holodiastolic flow reversal

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Authors and Affiliations

  1. Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA

    Mujtaba Saeed, Akila Bersali, Amr Darwish, Fatima Qamar, Dimitrios Maragiannis, Kinan Carlos El-Tallawi, Maan Malahfji & Dipan J. Shah

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  1. Mujtaba Saeed
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  2. Akila Bersali
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  7. Maan Malahfji
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Contributions

M.S. and A.B. wrote the main manuscript text, prepared the figures and the table. All authors reviewed the manuscript.

Corresponding author

Correspondence to Dipan J. Shah.

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Saeed, M., Bersali, A., Darwish, A. et al. Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Aortic Regurgitation. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02044-3

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