title: Comparison of severity of aortic regurgitation by cardiovascular magnetic resonance versus transthoracic echocardiography.
abstract: 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.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Ohio, USA.
authors.forename: Ruvin S
authors.initials: RS
authors.lastname: Gabriel
authors.forename: Rahul
authors.initials: R
authors.lastname: Renapurkar
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bolen
authors.forename: David
authors.initials: D
authors.lastname: Verhaert
authors.forename: Michael
authors.initials: M
authors.lastname: Leiber
authors.forename: Scott D
authors.initials: SD
authors.lastname: Flamm
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
mesh_terms: D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000503:physiopathology; D001783:Blood Flow Velocity; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016277:Ventricular Function, Left