SPC365

Incremental Value of Cardiac MRI Over Echocardiography in the Assessment of Aortic Regurgitation

Session: SESSÃO DE POSTERS 47 - AVALIAÇÃO CARDÍACA POR TC E/OU RM
Speaker: Samuel Azevedo

Congress: CPC 2025
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.3 Cardiac Magnetic Resonance
Session Type: Cartazes
FP Number: ---
Authors: Samuel Azevedo; C.Santos-Jorge; Pedro Freitas; Carla Reis; Cláudia Silva; Pedro Lopes; Francisco Gama; Sara Guerreiro; João Abecasis; Pedro Pulido Adragão; Regina Ribeiras; António Ferreira

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Introduction</strong><br />
Transthoracic echocardiography (TTE) is the primary imaging modality for evaluating aortic regurgitation (AR) and plays a central role in surgical decision-making. However, TTE has limitations in assessing AR severity, particularly in cases with eccentric regurgitant jets or borderline findings. Cardiac MRI (cMRI) has emerged as a complementary tool, providing precise volumetric and functional data. This study aims to validate the role of cMRI in refining AR severity.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Methods</strong><br />
This retrospective, single-center study included patients with AR who underwent cMRI between 2019-2024. Patients with a time gap &gt; 6 months between TTE and cMRI were excluded. AR severity on TTE was graded using the PISA method, along with vena contracta, jet width, and holodiastolic flow reversal when applicable. On cMRI (1.5T), phase-contrast velocity-encoded sequences quantified aortic regurgitant volume and regurgitant fraction (RF), with significant AR defined as RF &ge; 35% as suggested by several papers.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Results</strong><br />
A total of 177 patients (mean age 65 years, 67% male) were analyzed. Mean left ventricular ejection fraction (LVEF) by cMRI was 49&plusmn;15%. Left ventricular (LV) volumes were consistently underestimated by TTE compared to cMRI (dilated LV in 45.2% vs. 59.3%, median LVEDVi: 81 mL/m&sup2; [IQR 63&ndash;98] vs. 110 mL/m&sup2; [IQR 87&ndash;139]). Median regurgitant volume and RF on cMRI were 18 mL (IQR 7&ndash;37) and 22% (IQR 10&ndash;36).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Figure 1a</strong> shows AR severity reclassification achieved with cMRI. Among 63 patients with moderate AR on TTE, cMRI reclassified 24 (38.1%) as significant AR. Of 12 moderate-to-severe AR cases, 6 (50%) were reclassified as significant AR. All 13 severe AR cases identified by TTE were confirmed by cMRI. The agreement between TTE and cMRI in identifying severe aortic regurgitation was poor (Cohen&rsquo;s Kappa = 0.11; p&lt;0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000">In patients with LV dilation or dysfunction but no significant AR (n = 78), cMRI provided alternative diagnoses in 47 cases (60%): ischemic late-gadolinium enhancement (LGE) in 19, non-ischemic LGE in 22, and both in 6 patients.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000">During follow-up, 22 patients underwent surgery for isolated AR <strong>(Figure 1b)</strong>. Only 12 met guideline-recommended criteria for intervention (8 Class I, 2 Class Ib, 2 Class IIa/IIb). Cardiac MRI findings guided the surgical decision-making in the remaining 10 patients.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Conclusion</strong><br />
Cardiac MRI provides significant incremental value in evaluating aortic regurgitation, particularly in borderline and complex cases. While TTE remains the cornerstone imaging modality, cMRI can refine AR severity assessment and guide clinical decision-making, optimizing patient management.</span></span></span></p>

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