Improved Quantification of Aortic Regurgitation with Direct Regurgitant Jet Measurement by 4D Flow CMR in Complex Congenital Heart Disease.

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Brynn S Connor, Makoto Takei, Daniel E Clark, Shiraz A Maskatia
{"title":"Improved Quantification of Aortic Regurgitation with Direct Regurgitant Jet Measurement by 4D Flow CMR in Complex Congenital Heart Disease.","authors":"Brynn S Connor, Makoto Takei, Daniel E Clark, Shiraz A Maskatia","doi":"10.1016/j.jocmr.2025.101876","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Due to the presence of complex flow states and significant jet eccentricity in patients with congenital heart disease (CHD), accurate quantification of aortic regurgitation (AR) using standard echocardiographic or conventional cardiac magnetic resonance (CMR) imaging measures remains challenging. Four-dimensional flow (4DF) CMR permits transvalvular flow quantification under non-laminar flow states, although has not been well validated for AR quantification in CHD.</p><p><strong>Methods: </strong>In 186 patients with moderate or complex CHD, we evaluated the agreement between different methods of AR quantification by 4DF CMR when compared to volumetry. Regurgitant flow volumes were measured (1) conventionally on time-resolved, velocity-encoded 4DF sequences at the aortic annulus, sinotubular junction (STJ), and ascending aorta (AAo), and via (2) direct regurgitant jet quantification 5mm proximal to the vena contracta.</p><p><strong>Results: </strong>Moderate overall agreement in AR quantification was observed between study methods (ρ=0.58-0.73). Compared with conventional flow quantification at the annulus, STJ, and AAo, direct regurgitant jet measurements showed improved correlation with volumetry (ρ=0.76), especially in patients with significant aortic dilation (r=0.95-0.97). In this latter group, regurgitant flow quantification at all other aortic levels resulted in AR severity classifications that were nearly a full grade lower (mean aortic regurgitant fraction difference: 7-12% ± 10-12%; p<0.001).</p><p><strong>Conclusions: </strong>4DF CMR permits AR quantification in complex CHD with comparable accuracy to volumetry. Under non-laminar or complex flow states, as observed with significant aortic dilation, direct regurgitant jet measurements may be preferable to regurgitant flow quantification at all other aortic levels.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101876"},"PeriodicalIF":4.2000,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Magnetic Resonance","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jocmr.2025.101876","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Due to the presence of complex flow states and significant jet eccentricity in patients with congenital heart disease (CHD), accurate quantification of aortic regurgitation (AR) using standard echocardiographic or conventional cardiac magnetic resonance (CMR) imaging measures remains challenging. Four-dimensional flow (4DF) CMR permits transvalvular flow quantification under non-laminar flow states, although has not been well validated for AR quantification in CHD.

Methods: In 186 patients with moderate or complex CHD, we evaluated the agreement between different methods of AR quantification by 4DF CMR when compared to volumetry. Regurgitant flow volumes were measured (1) conventionally on time-resolved, velocity-encoded 4DF sequences at the aortic annulus, sinotubular junction (STJ), and ascending aorta (AAo), and via (2) direct regurgitant jet quantification 5mm proximal to the vena contracta.

Results: Moderate overall agreement in AR quantification was observed between study methods (ρ=0.58-0.73). Compared with conventional flow quantification at the annulus, STJ, and AAo, direct regurgitant jet measurements showed improved correlation with volumetry (ρ=0.76), especially in patients with significant aortic dilation (r=0.95-0.97). In this latter group, regurgitant flow quantification at all other aortic levels resulted in AR severity classifications that were nearly a full grade lower (mean aortic regurgitant fraction difference: 7-12% ± 10-12%; p<0.001).

Conclusions: 4DF CMR permits AR quantification in complex CHD with comparable accuracy to volumetry. Under non-laminar or complex flow states, as observed with significant aortic dilation, direct regurgitant jet measurements may be preferable to regurgitant flow quantification at all other aortic levels.

4D血流CMR直接反流喷射测量对复杂先天性心脏病主动脉反流定量的改进。
背景:由于先天性心脏病(CHD)患者存在复杂的血流状态和明显的射流偏心,使用标准超声心动图或常规心脏磁共振(CMR)成像措施准确量化主动脉瓣反流(AR)仍然具有挑战性。四维流动(4DF) CMR允许非层流状态下的跨瓣膜流动量化,尽管尚未很好地验证冠心病的AR量化。方法:在186例中度或复杂冠心病患者中,我们评估了4DF CMR定量AR的不同方法与容积法的一致性。(1)常规测量主动脉环、窦小管交界处(STJ)和升主动脉(AAo)的时间分辨、速度编码的4DF序列,并通过(2)近静脉收缩处5mm的直接反流喷射量化。结果:两种研究方法在AR定量方面的总体一致性中等(ρ=0.58-0.73)。与传统的环、STJ和AAo流量量化相比,直接反流喷射测量与容积测量的相关性更高(ρ=0.76),特别是在主动脉明显扩张的患者中(r=0.95-0.97)。在后一组中,所有其他主动脉水平的反流量化导致AR严重程度分类几乎低了整整一个等级(平均主动脉反流分数差:7-12%±10-12%;结论:4DF CMR可用于复杂冠心病的AR定量,准确度与容积法相当。在非层流或复杂血流状态下,如观察到明显的主动脉扩张,直接测量反流射流可能比在所有其他主动脉水平测量反流流更可取。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信