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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

  • Ulf Neisius
  • Connie W. Tsao
  • Thomas H. Hauser
  • Apranta D. Patel
  • Patrick Pierce
  • Eyal Ben-Assa
  • Reza Nezafat
  • Warren J. ManningEmail author
Original Paper

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.

Keywords

Aortic regurgitation Aortic valve surgery Observer variation Remodeling Magnetic resonance imaging Transthoracic echocardiography 

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

Notes

Acknowledgements

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

Compliance with ethical standards

Conflict of interest

No conflicts of interest, financial or otherwise, are declared by the authors.

Supplementary material

10554_2019_1682_MOESM1_ESM.docx (20 kb)
Supplementary file1 (DOCX 20 kb)

References

  1. 1.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 129:2440–2492CrossRefGoogle Scholar
  2. 2.
    Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, Little SH, Shah DJ, Shernan S, Thavendiranathan P, Thomas JD, Weissman NJ (2017) Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 30:303–371.  https://doi.org/10.1016/j.echo.2017.01.007 CrossRefGoogle Scholar
  3. 3.
    Didier D, Ratib O, Lerch R, Friedli B (2000) Detection and quantification of valvular heart disease with dynamic cardiac MR imaging. Radiographics 20:1279–1299.  https://doi.org/10.1148/radiographics.20.5.g00jl111279 CrossRefGoogle Scholar
  4. 4.
    Dall’Armellina E, Hamilton C, Hundley G (2007) Assessment of blood flow and valvular heart disease using phase-contrast cardiovascular magnetic resonance. Echocardiography 24:207–216.  https://doi.org/10.1111/j.1540-8175.2007.00377.x CrossRefGoogle Scholar
  5. 5.
    Cawley PJ, Hamilton-Craig C, Owens DS, Krieger EV, Strugnell WE, Mitsumori L, D’Jang CL, Schwaegler RG, Nguyen KQ, Nguyen B, Maki JH, Otto CM (2013) Prospective comparison of valve regurgitation quantitation by cardiac magnetic resonance imaging and transthoracic echocardiography. Circ Cardiovasc Imaging 6:48–57.  https://doi.org/10.1161/CIRCIMAGING.112.975623 CrossRefGoogle Scholar
  6. 6.
    Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Bax JJ, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Pieter Kappetein A, Kassab R, Lip GYH, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33:2451–2496.  https://doi.org/10.1093/eurheartj/ehs109 CrossRefGoogle Scholar
  7. 7.
    Bellenger NG, Burgess MI, Ray SG et al (2000) Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Hear J 21:1387–1396CrossRefGoogle Scholar
  8. 8.
    Puntmann VO, Gebker R, Duckett S, Mirelis J, Schnackenburg B, Graefe M, Razavi R, Fleck E, Nagel E (2013) Left ventricular chamber dimensions and wall thickness by cardiovascular magnetic resonance: comparison with transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 14:240–246.  https://doi.org/10.1093/ehjci/jes145 CrossRefGoogle Scholar
  9. 9.
    Ong G, Redfors B, Crowley A, Abdel-Qadir H, Harrington A, Liu Y, Lafrenière-Roula M, Leong-Poi H, Peterson MD, Connelly KA (2018) Evaluation of left ventricular reverse remodeling in patients with severe aortic regurgitation undergoing aortic valve replacement: comparison between diameters and volumes. Echocardiography 35:142–147.  https://doi.org/10.1111/echo.13750 CrossRefGoogle Scholar
  10. 10.
    Gelfand EV, Hughes S, Hauser TH, Yeon SB, Goepfert L, Kissinger KV, Rofsky NM, Manning WJ (2006) Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography. J Cardiovasc Magn Reson 8:503–507.  https://doi.org/10.1080/10976640600604856 CrossRefGoogle Scholar
  11. 11.
    Khan JN, Singh A, Nazir SA, Kanagala P, Gershlick AH, McCann GP (2015) Comparison of cardiovascular magnetic resonance feature tracking and tagging for the assessment of left ventricular systolic strain in acute myocardial infarction. Eur J Radiol 84:840–848.  https://doi.org/10.1016/j.ejrad.2015.02.002 CrossRefGoogle Scholar
  12. 12.
    Castillo E, Osman N, El-Shehaby I, Pan L, Jerosch-Herold M, Lai S, Bluemke D, Lima J (2005) Quantitative assessment of regional myocardial function with MR-tagging in a multi-center study: interobserver and intraobserver agreement of fast strain analysis with Harmonic Phase (HARP) MRI. J Cardiovasc Magn Reson 7:783–791.  https://doi.org/10.1080/10976640500295417 CrossRefGoogle Scholar
  13. 13.
    Popović ZB, Desai MY, Griffin BP (2018) Decision making with imaging in asymptomatic aortic regurgitation. JACC Cardiovasc Imaging 11:1499–1513.  https://doi.org/10.1016/j.jcmg.2018.05.027 CrossRefGoogle Scholar
  14. 14.
    Gao SA, Polte CL, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O (2018) Evaluation of the integrative algorithm for grading chronic aortic and mitral regurgitation severity using the current American Society of Echocardiography Recommendations: to discriminate severe from moderate regurgitation. J Am Soc Echocardiogr 31:1002–1012.e2.  https://doi.org/10.1016/j.echo.2018.04.002 CrossRefGoogle Scholar
  15. 15.
    Uretsky S, Supariwala A, Nidadovolu P, Khokhar SS, Comeau C, Shubayev O, Campanile F, Wolff SD (2010) Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation. J Cardiovasc Magn Reson 12:32.  https://doi.org/10.1186/1532-429X-12-32 CrossRefGoogle Scholar
  16. 16.
    Dulce M, Mostbeck G, O’Sullivan M, Cheitlin M, Caputo G, Higgins C (1992) Severity of aortic regurgitation: interstudy reproducibility of measurements with velocity-encoded cine MRI imaging. Radiology 185:235–240CrossRefGoogle Scholar
  17. 17.
    Ley S, Eichhorn J, Ley-Zaporozhan J, Ulmer H, Schenk JP, Kauczor HU, Arnold R (2007) Evaluation of aortic regurgitation in congenital heart disease: value of MR imaging in comparison to echocardiography. Pediatr Radiol 37:426–436.  https://doi.org/10.1007/s00247-007-0414-4 CrossRefGoogle Scholar
  18. 18.
    Kutty S, Whitehead KK, Natarajan S, Harris MA, Wernovsky G, Fogel MA (2009) Qualitative echocardiographic assessment of aortic valve regurgitation with quantitative cardiac magnetic resonance: a comparative study. Pediatr Cardiol 30:971–977.  https://doi.org/10.1007/s00246-009-9490-6 CrossRefGoogle Scholar
  19. 19.
    Harris AW, Krieger EV, Kim M, Cawley PJ, Owens DS, Hamilton-Craig C, Maki J, Otto CM (2017) Cardiac magnetic resonance imaging versus transthoracic echocardiography for prediction of outcomes in chronic aortic or mitral regurgitation. Am J Cardiol 119:1074–1081.  https://doi.org/10.1016/j.amjcard.2016.12.017 CrossRefGoogle Scholar
  20. 20.
    Myerson SG, D’arcy J, Mohiaddin R, Greenwood JP, Karamitsos TD, Francis JM, Banning AP, Christiansen JP, Neubauer S (2012) Aortic regurgitation quantification using cardiovascular magnetic resonance: association with clinical outcome. Circulation 126:1452–1460.  https://doi.org/10.1161/CIRCULATIONAHA.111.083600 CrossRefGoogle Scholar
  21. 21.
    Polte CL, Gao SA, Johnsson ÅA, Lagerstrand KM, Bech-Hanssen O (2017) Characterization of chronic aortic and mitral regurgitation undergoing valve surgery using cardiovascular magnetic resonance. Am J Cardiol 119:2061–2068.  https://doi.org/10.1016/j.amjcard.2017.03.041 CrossRefGoogle Scholar
  22. 22.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St. John Sutton M, Stewart W (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108.  https://doi.org/10.1016/j.euje.2005.12.014 CrossRefGoogle Scholar
  23. 23.
    Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER, Vogel-Claussen J, Turkbey EB, Williams R, Plein S, Tee M, Eng J, Bluemke DA (2015) Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson 17:29.  https://doi.org/10.1186/s12968-015-0111-7 CrossRefGoogle Scholar
  24. 24.
    Stone PH, Clark RD, Goldschlager N, Selzer A, Cohn K (1984) Determinants of prognosis of patients with aortic regurgitation who undergo aortic valve replacement. J Am Coll Cardiol 3:1118–1126.  https://doi.org/10.1016/S0735-1097(84)80168-0 CrossRefGoogle Scholar
  25. 25.
    Bonow RO, Rosing DR, McIntosh CL, Jones M, Maron BJ, Lan KK, Lakatos E, Bacharach SL, Green MV, Epstein SE (1983) The natural history of asymptomatic patients with aortic regurgitation and normal left ventricular function. Circulation 68:509–517.  https://doi.org/10.1161/01.CIR.68.3.509 CrossRefGoogle Scholar
  26. 26.
    Uretsky S, Gillam L, Lang R, Chaudhry FA, Argulian E, Supariwala A, Gurram S, Jain K, Subero M, Jang JJ, Cohen R, Wolff SD (2015) Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial. J Am Coll Cardiol 65:1078–1088.  https://doi.org/10.1016/j.jacc.2014.12.047 CrossRefGoogle Scholar
  27. 27.
    Penicka M, Vecera J, Mirica DC, Kotrc M, Kockova R, Van Camp G (2017) Prognostic implications of magnetic resonance-derived quantification in asymptomatic patients with organic mitral regurgitation: comparison with Doppler echocardiography-derived integrative approach. Circulation 137:1349–1360.  https://doi.org/10.1161/CIRCULATIONAHA.117.029332 CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Medicine (Cardiovascular Division), Harvard Medical SchoolBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Institute of Medical Engineering and ScienceMassachusetts Institute of TechnologyCambridgeUSA
  3. 3.Department of Radiology, Harvard Medical SchoolBeth Israel Deaconess Medical CenterBostonUSA

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