Cardiovascular magnetic resonance quantification of aortic regurgitation identified 85% of patients with regurgitant fraction >33% who needed surgery, compared to 8% with ≤33%.
Does cardiovascular magnetic resonance quantification of aortic regurgitation predict the future need for surgery in asymptomatic patients with moderate or severe AR?
113 asymptomatic adults (≥18 years) with moderate or severe chronic aortic regurgitation on echocardiography. Excluded: presence of other significant valve disease or clinical/angiographic evidence for coronary disease.
Cardiovascular magnetic resonance (CMR) quantification of aortic regurgitation (specifically regurgitant fraction and regurgitant volume)
Progression to symptoms or other established indications for surgery (excessive LV dilation or reduced LV function)composite
CMR-quantified aortic regurgitant fraction >33% is highly predictive of progression to symptoms or the need for surgery in asymptomatic patients with moderate-to-severe aortic regurgitation.
Background— Current indications for surgery in patients with significant aortic regurgitation (AR) focus on symptoms and left ventricular dilation/dysfunction. However, prognosis is already reduced by this stage, and earlier identification of patients for surgery could be beneficial. Quantifying the regurgitation may help, but there are limited data on its link with outcome. Cardiovascular magnetic resonance (CMR) can accurately quantify AR, and we examined whether this was associated with the future need for surgery. Methods and Results— One hundred thirteen patients with echocardiographic moderate or severe AR were monitored for up to 9 years (mean 2.6±2.1 years) following a CMR scan, and the progression to symptoms or other indications for surgery was monitored. AR quantification identified outcome with high accuracy: 85% of the 39 subjects with regurgitant fraction >33% progressed to surgery (mostly within 3 years) in comparison with 8% of 74 subjects with regurgitant fraction ≤33% ( P 246 mL had good, although lower, discriminatory ability (area under the curve 0.88), but the combination of this measure with regurgitant fraction provided the best discriminatory power. Conclusions— High degrees of CMR-quantified AR were associated with the development of symptoms or other indications for surgery. Quantifying AR showed slightly better discriminatory ability than “gold standard” CMR ventricular volume assessment. This could provide a new paradigm for the timing of surgical intervention but requires confirmation in a clinical trial.
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Saul Myerson
Joanna d’Arcy
Raad Mohiaddin
Circulation
University of Leeds
Royal Brompton Hospital
Lung Institute
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Myerson et al. (Sun,) reported a other. Cardiovascular magnetic resonance quantification of aortic regurgitation identified 85% of patients with regurgitant fraction >33% who needed surgery, compared to 8% with ≤33%.
www.synapsesocial.com/papers/6978dec71be5285e59bcd370 — DOI: https://doi.org/10.1161/circulationaha.111.083600