Qualitative echocardiographic assessment of aortic valve regurgitation with quantitative cardiac magnetic resonance: a comparative study.
ABSTRACT This study examined the correlation of echocardiography (ECHO) and Cardiac Magnetic Resonance (CMR) in the assessment of aortic valve regurgitation (AR) in children and young adults with congenital heart disease. We hypothesized that qualitative ECHO assessment correlates insufficiently with quantitative CMR data and compared subjective ECHO evaluations with objective measurement of regurgitant fractions (RF) by CMR. Patients who had both ECHO and CMR assessments of AR within 60 days of each other were included. The qualitative ECHO assessment (mild, moderate, severe) of AR and left ventricular dimension at end diastole were recorded. RF was quantified by CMR using phase-contrast velocity mapping. Repeat ECHO review and grading of AR was performed by a blinded single reader in a randomly chosen subgroup of patients. In 43 patients studied, statistical significance was observed in the CMR-RF between mild and moderate, and between mild and severe ECHO grades. There was significant overlap of objective RF between subjective grades. Mild ECHO AR corresponded to an RF (%) of 0-29, moderate 1-40, and severe 5-58. Overlap was more significant at moderate and severe grades. Results were similar in the group in whom a single reader interpreted the ECHO assessment. In conclusion, results derived from a real-life multiple-reader ECHO laboratory showed inconsistencies in ECHO grading of AR, with a wide range of objectively measured RF within a given ECHO grade. ECHO is less reliable in identifying more severe AR, often overestimating severity. Quantitative CMR is a potentially useful supplement to ECHO for management decisions and assessments of medical and surgical therapies in children and young adults with AR.
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ABSTRACT: Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.Journal of Cardiovascular Magnetic Resonance 06/2013; 15(1):51. · 4.44 Impact Factor
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ABSTRACT: The timing of aortic valve intervention (AVI) in pediatric patients with chronic aortic insufficiency (AI) is largely based on adult experience, which is fraught with uncertainty and controversy. Current adult guidelines in the absence of symptoms use left ventricular (LV) systolic function and LV dimensions to guide AVI timing, with few studies translating these recommendations to pediatric patients. This article reviews the current guidelines for AVI timing in chronic AI along with the emerging data for pediatric patients.Pediatric Cardiology 09/2014; 35(8). · 1.55 Impact Factor
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ABSTRACT: Evaluation of: Myerson SG, d'Arcy J, Mohiaddin R et al. Aortic regurgitation quantification using cardiovascular magnetic resonance: association with clinical outcome. Circulation 126(12), 1452-1460 (2012). Guidelines on valve replacement recommend aortic valve replacement for patients with severe aortic regurgitation (AR) with symptoms or left ventricular (LV) dysfunction. However, the optimal timing of surgery for asymptomatic AR patients without LV dilation or dysfunction is not known. There are data to suggest that excess volume load imposed by AR may not only produce subclinical LV dysfunction, but produce neurohormonal activation similar to the heart failure syndrome resulting in reduced survival. The study by Myerson et al. is the first to investigate the predictive ability of cardiac MRI (CMR) for the outcome of asymptomatic patients with AR. They studied 113 asymptomatic patients with moderate-to-severe AR on echocardiography in four centers. A total of 39 (35%) patients developed symptoms or an indication for surgery over a mean follow-up period of 2.6 years. AR volume, AR regurgitant fraction, LV end-diastolic and end-systolic volumes had high discriminatory powers (area under curve of 0.96, 0.93, 0.88 and 0.78, respectively) to predict these events. Higher association with the outcome was observed when LV end-diastolic volume and regurgitant fraction were combined. A significantly higher number of patients with regurgitant fraction >33% were likely to progress to surgery compared with patients with a regurgitant fraction of <33% (85 vs 8%; p < 0.001). These results demonstrate a potential role for CMR for risk stratification of patients with asymptomatic moderate or severe AR, given the ability of CMR to accurately quantify AR and LV volumes. Based on the data presented, it is possible that we may be waiting too long to offer surgery in patients with severe AR.Future Cardiology 01/2013; 9(1):9-12.