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Echocardiographic Compared With CMR Evaluation of AR
Quick Takes
- When performed near-simultaneously, echo and CMR have overall good concordance in assessing AR severity.
- Overall, feasibility of Doppler quantitation of RegV was high, except for the PISA method, with a good correlation with CMR quantitation.
- Among other echo parameters, the most accurate in assessing AR was vena contracta width, and the least accurate was pressure half-time.
Study Questions:
What is the accuracy of the American Society of Echocardiography (ASE) aortic regurgitation (AR) guidelines against cardiac magnetic resonance (CMR)?
Methods:
The investigators graded patients with AR who underwent echocardiography and CMR <4 hours apart. AR severity was graded according to ASE guidelines. Quantitation of regurgitant volume (RegV) was performed with pulsed Doppler at the mitral annulus and right ventricular outflow compared with left ventricular (LV) outflow, and with proximal isovelocity surface area (PISA). Scatter plots with Pearson correlation coefficients and regression lines were used to present the correlation in parameters between transthoracic echocardiography (TTE) and CMR. Agreement plots were used to assess the agreement in measurements by using the Bland-Altman plot. Agreement between TTE and CMR in classifying AR severity was determined by using Cohen’s kappa statistic.
Results:
The authors studied 81 patients; median age was 52 years, and 58% had a bicuspid aortic valve. According to echo, 35 (43%) patients had mild AR, 18 (22%) moderate, 12 (15%) moderate to severe, and 16 (20%) had severe AR. The area under the curve (AUC) for detection of severe AR by CMR using ASE grading was 0.9 (82.4% sensitivity and 96.9% specificity). Feasibility of RegV quantitation was >88% using either echo volumetric method, and it was low for PISA (37%). The highest accuracy for echo parameters against CMR was seen with vena contracta width, jet width, and LV end-diastolic volume index (AUC, 0.86-0.89); pressure half-time had the lowest accuracy. Without RegV quantitation, a vena contracta width ≥0.5 cm and indexed LV end-diastolic volume ≥82 mL/m2 had 95.5% positive predictive value and 87.5% negative predictive value for identifying ≥ moderate to severe AR by CMR (AU, 0.89).
Conclusions:
The authors report that a simplified approach using vena contracta width and LV volumes can be used to reliably identify significant AR.
Perspective:
This cohort study reports that when performed near-simultaneously, echo and CMR have overall good concordance in assessing AR severity. Overall, feasibility of Doppler quantitation of RegV was high, except for the PISA method, with a good correlation with CMR quantitation. Among other echo parameters, the most accurate in assessing AR was vena contracta width, and the least accurate was pressure half-time. Additional larger studies are needed to evaluate the refined criteria of AR severity in larger and diverse populations and to explore the association of quantitative echo parameters with clinical variables and outcomes.
Clinical Topics: Noninvasive Imaging, Valvular Heart Disease, Echocardiography/Ultrasound, Magnetic Resonance Imaging
Keywords: Aortic Valve Insufficiency, Echocardiography, Magnetic Resonance Imaging
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