4D flow CMR quantification of atrioventricular valve regurgitation using the volumetric subtraction method was significantly associated with the composite outcome of death and heart transplantation listing (OR 1.53).
Observational (n=218)
Single-blind
Sí
Does 4D flow CMR accurately quantify atrioventricular valve regurgitation and predict clinical outcomes in post-Fontan patients compared to conventional echocardiography and CMR?
4D flow CMR provides reproducible quantification of atrioventricular valve regurgitation in post-Fontan patients that correlates with conventional methods and significantly predicts the risk of death or heart transplant listing.
Estimación del efecto: OR 1.53 (95% CI 1.13-2.07)
valor p: p=0.004
Atrioventricular valve regurgitation (AVVR) remains a significant complication post-Fontan. This study evaluates the accuracy of 4D flow AVVR quantification in post-Fontan patients by comparing 4D flow to conventional echocardiographic (AVVREcho) and CMR assessments. Patients in the multi-institutional FORCE registry with high-quality 4D flow CMR were included. Regurgitant fractions (RFs) were calculated using two 4D-flow based methods: AVVRAVV−Ao (4D), calculated from atrioventricular valve and aortic flows, and AVVRJet, which directly measures AVVR jet volume. 4D flow RFs and severity classifications were compared with AVVREcho and CMR-reported AVVR severity (AVVRReport−Cat), and examiner-reported RFs (AVVRReport−RF). Statistical tests included Pearson correlation, Cohen’s kappa, and Bland-Altman analysis. The study included 218 post-Fontan patients (median age: 16.2 years, IQR: 12.8–22.5) and 36.2% were female. Both 4D flow methods displayed excellent interobserver reproducibility (interclass correlation > 0.95) and RFs approximately 7% lower than AVVRReport−RF. AVVRAVV−Ao (4D) showed stronger agreement with AVVRReport−RF (κ = 0.50 95% CI: 0.25–0.75; r = 0.49, p < 0.01). AVVRJet demonstrated better concordance with AVVRReport−Cat (κ = 0.31 95% CI: 0.17–0.45). Both AVVRAVV−Ao (4D) (OR = 1.53, p = 0.004; AUC = 0.71) and AVVRJet (OR = 1.74, p = 0.002; AUC = 0.65) were associated significantly with the composite outcome of death and heart transplantation listing. This is the first study analyzing the accuracy of 4D flow AVVR quantification in post-Fontan patients, demonstrating reproducibility, prognostic value, and good concordance with conventional methods. These findings suggest that 4D flow AVVR quantification may serve as a complementary method for assessing AVVR in post-Fontan patients.
Ladha et al. (Tue,) conducted a observational in Atrioventricular valve regurgitation post-Fontan (n=218). 4D flow CMR AVVR quantification (AVVRAVV-Ao(4D)) vs. Conventional echocardiographic and 2D CMR assessments was evaluated on Composite outcome of death, listing for heart transplantation, or receipt of a transplant (OR 1.53, 95% CI 1.13-2.07, p=0.004). 4D flow CMR quantification of atrioventricular valve regurgitation using the volumetric subtraction method was significantly associated with the composite outcome of death and heart transplantation listing (OR 1.53).
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