Aortic regurgitation (AR) continues to be an important cause of morbidity and mortality
in pediatric patients. Although echocardiographic parameters are well established
for the adults, there are no clear cut-off values for AR severity in children. Cardiac
magnetic resonance (CMR) imaging is considered a “gold standard” for a quantitative
evaluation of the AR, but it is not widely available. This study assesses which echo
parameter can accurately define AR severity as assessed by CMR in pediatric patients.
A total of 27 pediatric patients (12 ± 3 years, range 6 to 18 years) with different
degree of AR underwent echo assessment within an average of 35 days from CMR. CMR
included phase-contrast velocity-encoded imaging for the measurement of regurgitant
fraction (RF). Severe AR was defined as RF >33%. Echo evaluation included vena contracta,
pressure half time, the ratio between the AR jet and the left ventricular outflow
tract diameter (jet/left ventricular outflow tract), presence of holodiastolic reversal
flow in abdominal aorta, the ratio between the velocity-time integral of the reversal
flow over the forward flow in descending aorta (echoRF). Among the studied parameters,
the strongest predictor of severe AR, as assessed by CMR, was echoRF. Receiver-operating
characteristic curve showed, for a cutoff >0.38, an area under the curve of 0.886
(p <0.0001), a sensitivity of 71%, and a specificity of 100%. Correlation coefficient
between echoRF and RF was R = 0.929 (p <0.0001). In conclusion, echoRF is a strong
echo-Doppler marker of severe AR in the pediatric population. This parameter should
be routinely added in the standard echo evaluation of pediatric patients with AR.
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Article info
Publication history
Published online: September 09, 2019
Received in revised form:
August 13,
2019
Received:
June 28,
2019
Identification
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© 2019 Elsevier Inc. All rights reserved.
