4D Flow CMR with retrospective valve tracking allowed direct quantification of complex left atrioventricular valve regurgitant jets in patients after AVSD correction, demonstrating excellent internal validation with aortic flow (r = 0.97, p < 0.001).
Cross-Sectional (n=32)
Single-blind
No
Does 4D Flow CMR with retrospective valve tracking accurately characterize and quantify left atrioventricular valve regurgitation in patients with corrected AVSD compared to echocardiography and conventional CMR?
4D Flow CMR with retrospective valve tracking provides a feasible and accurate method for directly quantifying complex, eccentric LAVV regurgitant jets in patients with corrected AVSD, overcoming the geometric limitations of standard echocardiography.
Effect estimate: r = 0.97
p-value: p=<0.001
BACKGROUND: To characterize and directly quantify regurgitant jets of left atrioventricular valve (LAVV) in patients with corrected atrioventricular septal defect (AVSD) by four-dimensional (4D)Flow Cardiovascular Magnetic Resonance (CMR), streamline visualization and retrospective valve tracking. METHODS: Medical ethical committee approval and informed consent from all patients or their parents were obtained. In 32 corrected AVSD patients (age 26 ± 12 years), echocardiography and whole-heart 4DFlow CMR were performed. Using streamline visualization on 2- and 4-chamber views, the angle between regurgitation and annulus was followed throughout systole. On through-plane velocity-encoded images reformatted perpendicular to the regurgitation jet the cross-sectional jet circularity index was assessed and regurgitant volume and fraction were calculated. Correlation and agreement between different techniques was performed with Pearson's r and Spearman's rho correlation and Bland-Altman analysis. RESULTS: In 8 patients, multiple regurgitant jets over the LAVV were identified. Median variation in regurgitant jet angle within patients was 36°(IQR 18-64°) on the 2-chamber and 30°(IQR 20-40°) on the 4-chamber. Regurgitant jets had a circularity index of 0.61 ± 0.16. Quantification of the regurgitation volume was feasible with 4DFlow CMR with excellent correlation between LAVV effective forward flow and aortic flow (r = 0.97, p < 0.001) for internal validation and moderate correlation with planimetry derived regurgitant volume (r = 0.65, p < 0.001) and echocardiographic grading (rho = 0.51, p = 0.003). CONCLUSIONS: 4DFlow CMR with streamline visualization revealed multiple, dynamic and eccentric regurgitant jets with non-circular cross-sectional shape in patients after AVSD correction. 4DFlow with retrospective valve tracking allows direct and accurate quantification of the regurgitation of these complex jets.
Calkoen et al. (Thu,) conducted a cross-sectional in Corrected atrioventricular septal defect (AVSD) (n=32). 4D Flow Cardiovascular Magnetic Resonance vs. Echocardiography and planimetry was evaluated on Correlation between LAVV effective forward flow and aortic flow (r = 0.97, p=<0.001). 4D Flow CMR with retrospective valve tracking allowed direct quantification of complex left atrioventricular valve regurgitant jets in patients after AVSD correction, demonstrating excellent internal validation with aortic flow (r = 0.97, p < 0.001).