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Aortic regurgitation quantification

Andreas A Kammerlander, Matthias Wiesinger, Franz Duca, Stefan Aschauer, Christina Binder, Caroline Zotter Tufaro, Christian Nitsche, Roza Badre-Eslam, Robert Schönbauer, Philipp Bartko, Dietrich Beitzke, Christian Loewe, Christian Hengstenberg, Diana Bonderman, Julia Mascherbauer
OBJECTIVES: This study investigated the diagnostic and prognostic value of cardiac magnetic resonance (CMR) imaging in chronic aortic regurgitation (AR). BACKGROUND: Accurate quantification of AR severity by echocardiography frequently remains difficult. CMR is recommended as the complementary method; however, its accuracy and prognostic utility remain unknown. METHODS: A total of 232 consecutive patients (34.5% were females 55.5 ± 19.8 years of age) with chronic AR (including 40 with moderate to severe and 44 with severe AR on echocardiography) underwent CMR within 4 weeks of echocardiography...
November 8, 2018: JACC. Cardiovascular Imaging
Elizabeth Lee, Blair Richards, Jimmy C Lu, Maryam Ghadimi Mahani, Adam L Dorfman, Sowmya Balasubramanian, Prachi P Agarwal
OBJECTIVE: This study aimed to assess variability in measurements and accurately quantify aortic regurgitation in patients with coexisting turbulent aortic flow using phase-contrast magnetic resonance. METHODS: All patients (n = 21) underwent phase-contrast magnetic resonance at 2 or more sites: ascending aorta, sinuses of Valsalva, and left ventricular outflow tract. The net flow/minute (NF), forward flow/minute (FF), regurgitant flow/minute (RF), and regurgitant fraction (RF%) were compared with the sum of superior vena cava and descending aortic flow/minute, left ventricular cardiac output, difference between the 2, and percentage difference, respectively...
November 6, 2018: Journal of Computer Assisted Tomography
Carmen P S Blanken, Emile S Farag, S Matthijs Boekholdt, Tim Leiner, Jolanda Kluin, Aart J Nederveen, Pim van Ooij, R Nils Planken
The most common types of left-sided valvular heart disease (VHD) in the Western world are aortic valve stenosis, aortic valve regurgitation, and mitral valve regurgitation. Comprehensive clinical evaluation entails both hemodynamic analysis and structural as well as functional characterization of the left ventricle. Cardiac magnetic resonance imaging (MRI) is an established diagnostic modality for assessment of left-sided VHD and is progressively gaining ground in modern-day clinical practice. Detailed flow visualization and quantification of flow-related biomarkers in VHD can be obtained using 4D flow MRI, an imaging technique capable of measuring blood flow in three orthogonal directions over time...
August 2018: Journal of Magnetic Resonance Imaging: JMRI
Bo Hwa Choi, Sung Min Ko, Je Kyoun Shin, Hyun Keun Chee, Jun Seok Kim, Jayoun Kim
Background Aortic valve calcification quantification using cardiac computed tomography (CCT) is a reliable marker for aortic stenosis (AS) in patients with bicuspid aortic valve (BAV) disease. Purpose To determine the association of Agatston aortic valve calcium score (AVCS) with morphological and hemodynamic characteristics of BAV and define cut-off AVCS for optimizing the grade of AS in patients with bicuspid AS. Material and Methods This study included 161 BAV patients with AS regardless of aortic regurgitation who underwent transthoracic echocardiography and CCT...
August 6, 2018: Acta Radiologica
Thomas d'Humières, Laureline Faivre, Elie Chammous, Jean-François Deux, Eric Bergoënd, Antonio Fiore, Costin Radu, Jean-Paul Couetil, Nicole Benhaiem, Geneviève Derumeaux, Jean-Luc Dubois-Randé, Julien Ternacle, Damien Fard, Pascal Lim
BACKGROUND: Aortic valve calcification (AVC) quantification is computed from multidetector computed tomography (MDCT). The aim of this study was to test the hypothesis that three-dimensional (3D) transthoracic echocardiography can be used to provide a bedside method to assess AVC. METHODS: The study included 94 patients (mean age, 78 ± 12 years; mean aortic valve [AV] area, 1.0 ± 0.6 cm2 ) referred for MDCT and echocardiography for AV assessment. Apical 3D full-volume data sets focused on the AV region were acquired during transthoracic echocardiography, and a region-growing algorithm was applied offline to compute 3D transthoracic echocardiographic AVC (AVC-3DEcho)...
October 2018: Journal of the American Society of Echocardiography
Daichi Akiyama, Takashi Nishimura, Hirohito Sumikura, Kei Iizuka, Toshihide Mizuno, Tomonori Tsukiya, Yoshiaki Takewa, Minoru Ono, Eisuke Tatsumi
Aortic insufficiency (AI) is an intractable complication during long term left ventricular assist device (LVAD) support. Conventional evaluation of AI depends on ultrasound evaluation, which is mainly a qualitative, not a quantitative method. The pathophysiology of AI during LVAD is shunt formation. Conversely, the methods to quantify the shunt of congenital heart disease are already established, and among these is the thermodilution technique. To develop an accurate quantification method for AI (namely, a shunt), we have adopted this conventional thermodilution technique...
October 2018: Artificial Organs
Francesca Ristalli, Salvatore Mario Romano, Miroslava Stolcova, Francesco Meucci, Giovanni Squillantini, Serafina Valente, Carlo Di Mario
BACKGROUND: Residual aortic regurgitation (AR) complicates a not negligible number of transcatheter aortic valve replacement (TAVR) procedures, and its entity is not always clear at intraprocedural angiographic and echocardiographic control. We applied a minimally invasive hemodynamic monitoring system (Pressure Recording Analytical Method, PRAM) in the setting of TAVR, with the aim of identifying parameters that may help in detection and quantification of residual AR. METHODS: We performed hemodynamic monitoring with PRAM in 43 patients undergoing trans-femoral TAVR...
July 19, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Nader Makki, Xu Ghao, Bryan Whitson, Satya Shreenivas, Juan Crestanello, Scott Lilly
BACKGROUND: Precise quantification of paravalvular aortic regurgitation (PAR) is challenging. Aortic regurgitation index (AR index) has been validated in transcatheter aortic valve replacement (TAVR) cohorts; however, accuracy is limited by heart rate dependency. Diastolic pressure time (DPT) index has been suggested as an alternative and also predicts mortality after TAVR. We chose to evaluate the left ventricular diastolic filling slope (LVDFS) as a surrogate of AR, and suggest it is less heart rate dependent than the AR index and comparable to DPT index...
July 18, 2018: Catheterization and Cardiovascular Interventions
Cristiane Nunes Martins, Bayard Gontijo Filho, Roberto Max Lopes, Francisco das Chagas Lima E Silva
BACKGROUND: Jatene surgery became the surgical procedure of choice to repair transposition of the great arteries (TGA) in neonates and infants. Late complications, mainly related to the pulmonary outflow tract and coronary arteries, are well known. The behavior of the neo-aortic valve is a cause of concern because of its potential for requiring late reoperation. OBJECTIVES: To assess the prevalence and risk factors of neo-aortic valve regurgitation in 127 patients in the late postoperative period of the Jatene surgery...
July 2018: Arquivos Brasileiros de Cardiologia
Ramji Iyer, Aaron Chalekian, Randy Lane, Mike Evans, Seung Yi, John Morris
Transcatheter Mitral Valve Replacement (TMVR) is currently under clinical investigation as a viable treatment option for mitral regurgitation (MR). Therefore, it is important to outline the key functional requirements of a TMVR prosthesis in order to provide an overall approach to assessing mitral valve replacement devices utilizing a combination of in vitro and preclinical methods. This article provides a review of the mitral valve disease as well as general considerations and guidance for developing a TMVR device based on International Industry Standards...
September 2018: Cardiovascular Engineering and Technology
Mats Lidén, Maciej Wodecki, Per Thunberg, Peter Rask
BACKGROUND: Flow measurements using cardiac magnetic resonance imaging (CMRI) enable quantification of the stroke volume, regurgitant volume (RV) and regurgitant fraction (RF) in patients with aortic regurgitation (AR). These variables are used to assess the severity of the valve disease and for the timing of surgery. The aim of the study was to investigate the impact of an increased heart rate on measurement of the RV and RF in patients with AR. METHODS: Among 13 patients with known moderate or severe AR, regurgitant flow measurements, using phase-contrast cine magnetic resonance imaging, were obtained in the ascending aorta...
September 2017: Journal of Heart Valve Disease
Franck Levy, Sylvestre Marechaux, Laura Iacuzio, Elie Dan Schouver, Anne Laure Castel, Manuel Toledano, Stephane Rusek, Vincent Dor, Christophe Tribouilloy, Gilles Dreyfus
BACKGROUND: Quantitative assessment of primary mitral regurgitation (MR) using left ventricular (LV) volumes obtained with three-dimensional transthoracic echocardiography (3D TTE) recently showed encouraging results. Nevertheless, 3D TTE is not incorporated into everyday practice, as current LV chamber quantification software products are time consuming. AIMS: To investigate the accuracy and reproducibility of new automated fast 3D TTE software (HeartModelA.I. ; Philips Healthcare, Andover, MA, USA) for the quantification of LV volumes and MR severity in patients with isolated degenerative primary MR; and to compare regurgitant volume (RV) obtained with 3D TTE with a cardiac magnetic resonance (CMR) reference...
August 2018: Archives of Cardiovascular Diseases
Stephan Stoebe, Michael Metze, Daniel Jurisch, Bhupendar Tayal, Kilian Solty, Ulrich Laufs, Dietrich Pfeiffer, Andreas Hagendorff
PURPOSE: The study compares the feasibility of the quantitative volumetric and semi-quantitative approach for quantification of chronic aortic regurgitation (AR) using different imaging modalities. METHODS: left ventricular (LV) volumes, regurgitant volumes (RVol) and regurgitant fractions (RF) were assessed retrospectively by 2D, 3D echocardiography and cMRI in 55 chronic AR patients. Semi-quantitative parameters were assessed by 2D echocardiography. RESULTS: 22 (40%) patients had mild, 25 (46%) moderate and 8 (14%) severe AR...
March 8, 2018: Echo Research and Practice
Giovanni Benfari, Stefano Nistri, Pompilio Faggiano, Marie-Annick Clavel, Caterina Maffeis, Maurice Enriquez-Sarano, Corrado Vassanelli, Andrea Rossi
BACKGROUND: Mitral regurgitation (MR) and elevated pulmonary artery pressure are common findings in patients with aortic valve stenosis (AS). The pathophysiologic role of quantitatively defined MR as a determinant of pulmonary hypertension (PH) is incompletely characterized across the whole spectrum of AS degrees. The purpose of the study was to investigate whether the quantification of MR reveals a link to PH in patients with AS. METHODS: Consecutive patients undergoing comprehensive echocardiography and presenting peak aortic velocity ≥ 2...
May 2018: Journal of the American Society of Echocardiography
Mohamed Abdel-Wahab, Mohammad Abdelghani, Yosuke Miyazaki, Erik W Holy, Constanze Merten, Dirk Zachow, Pim Tonino, Marcel C M Rutten, Frans N van de Vosse, Marie-Angele Morel, Yoshinobu Onuma, Patrick W Serruys, Gert Richardt, Osama I Soliman
OBJECTIVES: This study sought to compare a new quantitative angiographic technique to cardiac magnetic resonance-derived regurgitation fraction (CMR-RF) for the quantification of prosthetic valve regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). BACKGROUND: PVR after TAVR is challenging to quantify, especially during the procedure. METHODS: Post-replacement aortograms in 135 TAVR recipients were analyzed offline by videodensitometry to measure the ratio of the time-resolved contrast density in the left ventricular outflow tract to that in the aortic root (videodensitometric aortic regurgitation [VD-AR])...
February 12, 2018: JACC. Cardiovascular Interventions
G S Gulsin, A Singh, G P McCann
BACKGROUND: Over the last 25 years, cardiovascular magnetic resonance imaging (CMR) has emerged as an alternative to echocardiography for assessment of valvular heart disease (VHD). Although echo remains the first-line imaging modality for the assessment of patients with VHD, CMR can now provide a comprehensive assessment in many instances. Using a combination of techniques, CMR provides information on valve anatomy and enables quantitative analysis of the severity of the valve lesion...
December 29, 2017: BMC Medical Imaging
Julia Geiger, Amir A Rahsepar, Kenichiro Suwa, Alex Powell, Ahmadreza Ghasemiesfe, Alex J Barker, Jeremy D Collins, James C Carr, Michael Markl
BACKGROUND: Patients with bicuspid aortic valve (BAV) show altered hemodynamics in the ascending aorta that can be assessed by 4D flow MRI. PURPOSE: Comprehensive cardiac MRI was applied to test the hypothesis that BAV-mediated changes in aortic hemodynamics (wall shear stress [WSS] and velocity) are associated with parameters of left ventricular (LV) remodeling. STUDY TYPE: Retrospective data analysis. POPULATION: Forty-nine BAV patients (mean age = 50...
July 2018: Journal of Magnetic Resonance Imaging: JMRI
Géraldine Ong, Bjorn Redfors, Aaron Crowley, Husam Abdel-Qadir, Alana Harrington, Yangbo Liu, Myriam Lafrenière-Roula, Howard Leong-Poi, Mark D Peterson, Kim A Connelly
BACKGROUND: In patients with severe aortic regurgitation (AR), the left ventricular ejection fraction (LVEF) and left ventricle (LV) size are crucial for determining clinical prognosis and timing of valve intervention. In clinical practice, LV internal diameters obtained at end-diastole are used to assess the degree of LV dilatation. Whether quantification of LV volumes would provide more robust information as compared to LV linear dimensions is unknown. METHODS: We retrospectively analyzed preoperative and postoperative transthoracic echocardiograms of patients who underwent aortic valve replacement (AVR) for severe AR...
February 2018: Echocardiography
Ricardo A Spampinato, Cosima Jahnke, Ingo Paetsch, Sebastian Hilbert, Franziska Busch, Valerie Schloma, Yaroslava Dmitrieva, Fernanda Bonamigo Thome, Susanne Löbe, Elfriede Strotdrees, Gerhard Hindricks, Friedrich-Wilhelm Mohr, Michael A Borger
BACKGROUND: Reflux of the aortic regurgitation (AR) causes an increased diastolic reverse flow in the aorta and its branching vessels. We aimed to evaluate the feasibility and accuracy of Doppler measurements in the left subclavian artery (LSA) for quantification of AR in a cardiovascular magnetic resonance imaging (CMR) validation study. METHODS: Systolic and diastolic flow profiles of the LSA (subclavicular approach) were evaluated prospectively by use of pulsed wave Doppler in 59 patients (55...
January 2018: Journal of the American Society of Echocardiography
Mohammad Abdelghani, Yosuke Miyazaki, Ellen S de Boer, Jean-Paul Aben, Math van Sloun, Todd Suchecki, Marcel van 't Veer, Osama Soliman, Yoshinobu Onuma, Robbert de Winter, Pim A L Tonino, Frans N van de Vosse, Marcel C M Rutten, Patrick W Serruys
AIMS: Videodensitometric assessment of aortography provides a periprocedural quantitation of prosthetic valve regurgitation (PVR) after transcatheter aortic valve implantation. We sought to compare the videodensitometric parameters of PVR severity to the regurgitation fraction (RF) in a controlled in vitro setting. METHODS AND RESULTS: In a mock circulation system, a transcatheter balloon-expandable valve inserted at the aortic valve position was gradually deformed to induce different grades of paravalvular leakage and the RF was measured with a transonic flow probe...
January 20, 2018: EuroIntervention
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