New Imaging Markers of Clinical Outcome in Asymptomatic Patients with Severe Aortic Regurgitation

Radka Kočková, Hana Línková, Zuzana Hlubocká, Alena Pravečková, Andrea Polednová, Lucie Súkupová, Martin Bláha, Jiří Malý, Eva Honsová, David Sedmera, Martin Pěnička, Radka Kočková, Hana Línková, Zuzana Hlubocká, Alena Pravečková, Andrea Polednová, Lucie Súkupová, Martin Bláha, Jiří Malý, Eva Honsová, David Sedmera, Martin Pěnička

Abstract

Background: Determining the value of new imaging markers to predict aortic valve (AV) surgery in asymptomatic patients with severe aortic regurgitation (AR) in a prospective, observational, multicenter study. Methods: Consecutive patients with chronic severe AR were enrolled between 2015-2018. Baseline examination included echocardiography (ECHO) with 2- and 3-dimensional (2D and 3D) vena contracta area (VCA), and magnetic resonance imaging (MRI) with regurgitant volume (RV) and fraction (RF) analyzed in CoreLab. Results: The mean follow-up was 587 days (interquartile range (IQR) 296-901) in a total of 104 patients. Twenty patients underwent AV surgery. Baseline clinical and laboratory data did not differ between surgically and medically treated patients. Surgically treated patients had larger left ventricular (LV) dimension, end-diastolic volume (all p < 0.05), and the LV ejection fraction was similar. The surgical group showed higher prevalence of severe AR (70% vs. 40%, p = 0.02). Out of all imaging markers 3D VCA, MRI-derived RV and RF were identified as the strongest independent predictors of AV surgery (all p < 0.001). Conclusions: Parameters related to LV morphology and function showed moderate accuracy to identify patients in need of early AV surgery at the early stage of the disease. 3D ECHO-derived VCA and MRI-derived RV and RF showed high accuracy and excellent sensitivity to identify patients in need of early surgery.

Keywords: T1 mapping; aortic regurgitation; echocardiography; longitudinal strain; magnetic resonance imaging; vena contracta area.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Imaging markers. (A) Echocardiography derived three-dimensional vena contracta area; (B) echocardiography two-dimensional global longitudinal strain; (C) magnetic resonance—the left ventricular outflow tract (cine), red line—through-plane flow sequence slice position displayed on, Ao—aorta, LA—left atrium, LV—left ventricle, RV—right ventricle; (D) through-plane flow sequence at sinotubular junction level (STJ) of the aorta (displayed on (C)), the blue circle is a manually drawn region of interest where the blood flow and regurgitant volume and fraction are calculated. The exact copy of the region interest is in all four images, phantom—stationary phantom used for flow measurement correction; (E) flow-time curve based on (D)—blue line shows blood flow at STJ and red line show flow in stationary phantom; (F) native T1 mapping from modified Look–Locker Inversion recovery sequence (MOLLI) sequence, blue circle—a semi-automatically drawn region of interest within the blood pool, blue ellipsoid—a manually drawn region of interest within the myocardium at the level of the interventricular septum utilized for myocardial fibrosis calculation.
Figure 2
Figure 2
Receiver-operating characteristics curves of the MRI-derived: regurgitant volume (RV) and left ventricular end-diastolic volume index (LVEDVI); the 3D ECHO-derived: vena contracta area (VCA); 2D ECHO-derived: left ventricular end-systolic diameter (LVESD); RV and global longitudinal strain (GLS) to predict AV surgery.
Figure 3
Figure 3
(A) Kaplan–Meier curves for aortic valve surgery (AVR) in patients with 3D ECHO-derived VCA ≥30 mm2 vs. <30 mm2, (B) MRI-derived RV ≥45 mL vs. <45 mL; and (C) MRI-derived RF ≥34% vs. <34%.

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