Key result
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).
Why the study?
Atrioventricular valve regurgitation remains a significant complication post-Fontan, but the accuracy of 4D flow CMR quantification in these patients needed evaluation.
Does 4D flow CMR accurately quantify atrioventricular valve regurgitation and predict clinical outcomes in post-Fontan patients compared to conventional echocardiography and CMR?
Observational (n=218)
Single-blind
Yes
Does 4D flow CMR accurately quantify atrioventricular valve regurgitation and predict clinical outcomes in post-Fontan patients compared to conventional echocardiography and CMR?
Effect estimate: OR 1.53 (95% CI 1.13-2.07)
p-value: p=0.004
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.
May enhance risk stratification in post-Fontan patients; extends 4D flow CMR validation as reproducible predictor of death or transplant listing.
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.
No takes yet. Share an insight, caveat, or question.
Ladha et al. (2026) conducted an 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).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: