Comparison of Severity of Aortic Regurgitation by Cardiovascular Magnetic Resonance Versus Transthoracic Echocardiography

      Transthoracic echocardiography is the current standard for assessing aortic regurgitation (AR). AR severity can also be evaluated by flow measurement in the ascending aorta using cardiac magnetic resonance (CMR); however, the optimal site for flow measurement and the regurgitant fraction (RF) severity grading criteria that best compares with the transthoracic echocardiographic assessment of AR are not clear. The present study aimed to determine the optimal site and RF grading criteria for AR severity using phase-contrast flow measurements and CMR. A prospective observational study was performed of 107 consecutive patients who were undergoing CMR of the thoracic aorta. Using CMR, the AR severity and aortic dimensions were measured at 3 levels in the aorta (the sinotubular junction, mid-ascending aorta, and distal ascending aorta). The results were compared to the transthoracic echocardiographic grade of AR severity using multiple qualitative and quantitative criteria (grade 0, none; I+, mild; II+, mild to moderate; III+, moderate to severe; and IV+, severe). The mean RF values were significantly greater at the sinotubular junction than at the distal ascending aorta (13 ± 13.3% vs 9.4 ± 12.6%, respectively; p <0.001). The RF values that best defined AR severity using phase-contrast CMR were as follows: grade 0 to I+, <8%; grade II+, 8% to 19%; grade III+, 20 to 29%; and grade IV+, 30%) at the sinotubular or mid-ascending aorta. In conclusion, the quantitative RF values of AR severity using phase-contrast flow are best assessed in the proximal ascending aorta and differ from recognized quantitative echocardiographic criteria.
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        • Bonow R.O.
        • Carabello B.A.
        • Chatterjee K.
        • de Leon Jr, A.C.
        • Faxon D.P.
        • Freed M.D.
        • Gaasch W.H.
        • Lytle B.W.
        • Nishimura R.A.
        • O'Gara P.T.
        • O'Rourke R.A.
        • Otto C.M.
        • Shah P.M.
        • Shanewise J.S.
        2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease).
        J Am Coll Cardiol. 2008; 52: e1-e142
        • Zoghbi W.A.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • Kraft C.D.
        • Levine R.A.
        • Nihoyannopoulos P.
        • Otto C.M.
        • Quinones M.A.
        • Rakowski H.
        • Stewart W.J.
        • Waggoner A.
        • Weissman N.J.
        Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
        J Am Soc Echocardio. 2003; 16: 777-802
        • Grothues F.
        • Smith G.C.
        • Moon J.C.
        • Bellenger N.G.
        • Collins P.
        • Klein H.U.
        • Pennell D.J.
        Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy.
        Am J Cardiol. 2002; 90: 29-34
        • Hendel R.C.
        • Patel M.R.
        • Kramer C.M.
        • Poon M.
        • Hendel R.C.
        • Carr J.C.
        • Gerstad N.A.
        • Gillam L.D.
        • Hodgson J.M.
        • Kim R.J.
        • Kramer C.M.
        • Lesser J.R.
        • Martin E.T.
        • Messer J.V.
        • Redberg R.F.
        • Rubin G.D.
        • Rumsfeld J.S.
        • Taylor A.J.
        • Weigold W.G.
        • Woodard P.K.
        • Brindis R.G.
        • Hendel R.C.
        • Douglas P.S.
        • Peterson E.D.
        • Wolk M.J.
        • Allen J.M.
        • Patel M.R.
        ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology.
        J Am Coll Cardiol. 2006; 48: 1475-1497
        • Chatzimavroudis G.P.
        • Oshinski J.N.
        • Franch R.H.
        • Pettigrew R.I.
        • Walker P.G.
        • Yoganathan A.P.
        Quantification of the aortic regurgitant volume with magnetic resonance phase velocity mapping: a clinical investigation of the importance of imaging slice location.
        J Heart Valve Dis. 1998; 7: 94-101
        • Diebold B.
        • Delouche A.
        • Decesare A.
        • Delouche P.
        • Guglielmi J.P.
        • Herment A.
        Fluid mechanics of regurgitant jets and calculation of the effective regurgitant orifice in free or complex configurations.
        J Biomech. 2000; 33: 677-684
        • Thompson R.B.
        • McVeigh E.R.
        High temporal resolution phase contrast MRI with multiecho acquisitions.
        Magn Reson Med. 2002; 47: 499-512
        • Aurigemma G.
        • Reichek N.
        • Schiebler M.
        • Axel L.
        Evaluation of aortic regurgitation by cardiac cine magnetic resonance imaging: planar analysis and comparison to Doppler echocardiography.
        Cardiology. 1991; 78: 340-347
        • Globits S.
        • Frank H.
        • Mayr H.
        • Neuhold A.
        • Glogar D.
        Quantitative assessment of aortic regurgitation by magnetic resonance imaging.
        Eur Heart J. 1992; 13: 78-83
        • Kozerke S.
        • Schwitter J.
        • Pedersen E.M.
        • Boesiger P.
        Aortic and mitral regurgitation: quantification using moving slice velocity mapping.
        J Magn Reson Imaging. 2001; 14: 106-112
        • Sechtem U.
        • Pflugfelder P.W.
        • Cassidy M.M.
        • White R.D.
        • Cheitlin M.D.
        • Schiller N.B.
        • Higgins C.B.
        Mitral or aortic regurgitation: quantification of regurgitant volumes with cine MR imaging.
        Radiology. 1988; 167: 425-430
        • Gelfand E.V.
        • Hughes S.
        • Hauser T.H.
        • Yeon S.B.
        • Goepfert L.
        • Kissinger K.V.
        • Rofsky N.M.
        • Manning W.J.
        Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography.
        J Cardiovasc Magn Reson. 2006; 8: 503-507
        • Firmin D.N.
        • Nayler G.L.
        • Kilner P.J.
        • Longmore D.B.
        The application of phase shifts in NMR for flow measurement.
        Magn Reson Med. 1990; 14: 230-241
        • Kuzo R.S.
        • Pooley R.A.
        • Crook J.E.
        • Heckman M.G.
        • Gerber T.C.
        Measurement of caval blood flow with MRI during respiratory maneuvers: implications for vascular contrast opacification on pulmonary CT angiographic studies.
        AJR Am J Roentgenol. 2007; 188: 839-842
        • Kilner P.J.
        • Gatehouse P.D.
        • Firmin D.N.
        Flow measurement by magnetic resonance: a unique asset worth optimising.
        J Cardiovasc Magn Reson. 2007; 9: 723-728