Holodiastolic Flow Reversal at the Descending Aorta on Cardiac Magnetic Resonance is Neither Sensitive Nor Specific for Significant Aortic Regurgitation in Patients with Congenital Heart Disease.
Holodiastolic flow reversal in the descending aorta on echocardiogram suggests significant aortic regurgitation. The study aim was to determine whether the presence of holodiastolic flow reversal on cardiac magnetic resonance imaging (MRI) correlates with aortic valve regurgitant fraction. We retrospectively reviewed 166 cardiac MRIs (64 % male, age 14.1 ± 9.5 years) from January 2011 to May 2012 where velocity mapping was acquired at both the aortic valve and the descending aorta at the level of the diaphragm. Descending aorta velocity maps were checked for baseline offset using a static reference region. Holodiastolic flow reversal was defined as flow reversal throughout diastole both before and after baseline correction. Significant aortic regurgitation was defined as regurgitant fraction >10 %. Aortic valve regurgitant fraction was <10 % in 144 patients (Group A), 10-20 % inclusive in 7 patients (Group B), and >20 % in 15 patients (Group C). Though the aortic valve regurgitant fraction was significantly higher for patients with holodiastolic flow reversal versus those without (8.5 ± 14.2 vs. 3.8 ± 6.6 %, p = 0.02), holodiastolic flow reversal was present in 32 Group A patients (22 %). In comparison, 4 Group B patients (57 %) and 7 Group C patients (47 %) had holodiastolic flow reversal. The sensitivity (Groups B and C) was 0.5, and the specificity (Group A) was 0.78. Holodiastolic flow reversal in the descending aorta on cardiac MRI was neither sensitive nor specific for predicting significant aortic regurgitation in this study population. Holodiastolic flow reversal in the absence of significant aortic regurgitation may be a relatively common finding in patients with congenital heart disease.
Division of Cardiology, St. Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA, 19134, USA. Catherine.avitabile@tenethealth.com.|Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA. Catherine.avitabile@tenethealth.com.
Catherine M
CM
Avitabile
Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.|Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.|Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.
Kevin K
KK
Whitehead
Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.|Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.|Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.
Mark A
MA
Fogel
Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Daniel W
DW
Kim
Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Timothy S
TS
Kim
Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Julian D
JD
Rose
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.|Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.
Marc S
MS
Keller
Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Gregory L
GL
Fu
Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.|Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.|Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.
Matthew A
MA
Harris
D000293:Adolescent; D001013:Aorta, Thoracic; D001022:Aortic Valve Insufficiency; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D055815:Young Adult
Aortic regurgitation; Cardiac magnetic resonance imaging; Echocardiography; Holodiastolic flow reversal