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Assessment of the anatomic regurgitant orifice in aortic regurgitation: a clinical magnetic resonance imaging study
  1. Kurt Debl (kurt.debl{at}klinik.uni-regensburg.de)
  1. Klinikum der Universität Regensburg, Germany
    1. Behrus Djavidani
    1. Klinikum der Universität Regensburg, Germany
      1. Stefan Buchner
      1. Klinikum der Universität Regensburg, Germany
        1. Sabine Fredersdorf
        1. Klinikum der Universität Regensburg, Germany
          1. Franz-Xaver Schmid
          1. Klinikum der Universität Regensburg, Germany
            1. Josef Haimerl
            1. Krankenhaus Landshut-Achdorf, Germany
              1. Florian Poschenrieder
              1. Klinikum der Universität Regensburg, Germany
                1. Stefan Feuerbach
                1. Klinikum der Universität Regensburg, Germany
                  1. Günter Riegger
                  1. Klinikum der Universität Regensburg, Germany
                    1. Andreas Luchner
                    1. Klinikum der Universität Regensburg, Germany

                      Abstract

                      Background: The aim of our study was to determine whether planimetry of the anatomic regurgitant orifice (ARO) in patients with aortic regurgitation (AR) by magnetic resonance imaging (MRI) is feasible and whether ARO by MRI correlates with the severity of AR.

                      Methods and results: Planimetry of ARO by MRI was performed on a clinical magnetic resonance system (1.5 T Sonata, Siemens Medical Solutions) in 45 patients and correlated to the regurgitant fraction (RgF) and regurgitant volume (RgV) determined by MRI phase velocity mapping (PVM; MRI-RgF, MRI-RgV, n = 45) and to invasively quantified AR by supravalvular aortography (n = 32) and RgF upon cardiac catheterization (CATH-RgF, n = 15). Determination of ARO was possible in 98 % (44/45) of the patients with adequate image quality. MRI-RgF and CATH-RgF were modestly correlated (n = 15, r = 0.71, p < 0.01). ARO was closely correlated to MRI-RgF (n = 44, r = 0.88, p < 0.0001) and was modestly correlated to CATH-RgF (n = 14, r = 0.66, p = 0.01). Sensitivity and specificity of ARO to detect moderately severe and severe aortic regurgitation (defined as MRI-RgF > 40%) were 96 % and 95 % at a threshold of 0.28 cm2 (AUC = 0.99). Of note, sensitivity and specificity of ARO to detect moderately severe and severe AR at catheterization (defined as CATH-RgF > 40 % or supravalvular aortography > 3+) were 90 % and 91 % at a similar threshold of 0.28 2 (AUC = 0.95). Lastly, sensitivity and specificity of ARO to detect severe aortic regurgitation (defined as MRI-RgF > 50% and/or regurgitant volume > 60 ml) were 83 % and 97 % at a threshold of 0.48 2 (AUC = 0.97).

                      Conclusions: Visualization and planimetry of the ARO in patients with AR is feasible by MRI. There is a strong correlation of ARO to RgV and RgF assessed by PVM and to invasively graded AR at catheterisation. Therefore, determination of ARO by MRI is a new non-invasive measure for assessing the severity of AR.

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