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

Figures

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  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.

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  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.

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  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%.