Improved quantification of aortic regurgitation with direct regurgitant jet measurement by four-dimensional flow cardiovascular magnetic resonance in complex congenital heart disease

Figures

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  Fig. 1. Consort diagram outlining patient selection criteria. CTD connective tissue disease, dTGA d-transposition of the great arteries, DORV double outlet right ventricle, ccTGA congenitally corrected transposition of the great arteries

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  Fig. 2. Representative imaging planes used for quantification of aortic flow volumes. Forward and regurgitant flow quantification was performed at the aortic annulus (a, b), sinotubular junction (c, d), and ascending aorta (e, f). Direct regurgitant jet measurements were performed 5 mm beneath the annular plane (g, h) with orthogonal angulation

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  Fig. 3. Direct regurgitant flow quantification in the presence of multiple, eccentric regurgitant jets. Two separate regurgitant jets are visualized in the coronal (a) and axial (b) planes. Regurgitant flow volumes for each regurgitant jet were separately quantified via measurements performed 5 mm beneath the annular plane and angulated perpendicular to the jet direction (c, d)

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  Fig. 4. Comparison of aortic RF values obtained with regurgitant flow quantification in (1) conventional 4DF CMR aortic imaging planes (a–d) and on (2) direct regurgitant jet measurement (e–g). Comparisons were made using volumetry as the reference standard. There was moderate intermethod agreement in aortic RF quantification between study methods (ρ = 0.53–0.76). However, aortic RF values obtained via direct regurgitant jet measurement were more closely correlated with volumetry (ρ = 0.76) RF regurgitant fraction

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  Fig. 5. Aortic forward (a) and regurgitant (b) flow quantification via each study method. No significant differences were observed in forward flow measurements obtained at each aortic level, which similarly demonstrated good overall correlation with the left ventricular SV, as assessed on planimetry. When compared to flow quantification in conventional aortic imaging planes, RVol were significantly higher with direct regurgitant jet measurement and volumetric-based assessment. AV (S) aortic valve (static plane), AV (T) aortic valve (annular tracking), STJ sinotubular junction, AAo ascending aorta, LV left ventricular, SV stroke volume, RVol regurgitant volume

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  Fig. 6. Bland-Altman plots comparing aortic RF quantification between 4DF study methods and volumetry in patients with aortic dilation (≥4.0 cm or Z-score ≥ +2). The mean aortic RF (solid line) and difference between aortic RF measurements (dashed lines) on 4DF CMR versus volumetry are depicted. Direct jet aortic RF values (r = 0.95–0.97 v. r = 0.69) were more closely correlated with volumetry in patients with significant aortic dilation. RF regurgitant fraction