Postigo Andrea, Pérez-David Esther, Revilla Ana, Raquel Ladrón Abia, González-Mansilla Ana, Prieto-Arévalo Raquel, Espinosa M Ángeles, López-Jimenez Rosa Ana, Sevilla Teresa, Urueña Noelia, Martínez-Legazpi Pablo, Oliver José M, Fernández-Avilés Francisco, J Alberto San Román, Bermejo Javier
Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain.
Instituto de Ciencias del Corazón. Hospital Clínico Universitario de Valladolid, and CIBERCV, Valladolid, Spain.
Eur Heart J Cardiovasc Imaging. 2022 Feb 22;23(3):392-401. doi: 10.1093/ehjci/jeaa338.
Timing surgery in chronic aortic regurgitation (AR) relies mostly on echocardiography. However, cardiac magnetic resonance (CMR) may be more accurate for quantifying regurgitation and left ventricular (LV) remodelling. We aimed to compare the technical and clinical efficacies of echocardiography and CMR to account for the severity of the disease, the degree of LV remodelling, and predict AR-related outcomes.
We studied 263 consecutive patients with isolated AR undergoing echocardiography and CMR. After a median follow-up of 33 months, 76 out of 197 initially asymptomatic patients reached the primary endpoint of AR-related events: 6 patients (3%) were admitted for heart failure, and 70 (36%) underwent surgery. Adjusted survival models based on CMR improved the predictions of the primary endpoint based on echocardiography: R2 = 0.37 vs. 0.22, χ2 = 97 vs. 49 (P < 0.0001), and C-index = 0.80 vs. 0.70 (P < 0.001). This resulted in a net classification index of 0.23 (0.00-0.46, P = 0.046) and an integrated discrimination improvement of 0.12 (95% confidence interval 0.08-0.58, P = 0.02). CMR-derived regurgitant fraction (<28, 28-37, or >37%) and LV end-diastolic volume (<83, 183-236, or >236 mL) adequately stratified patients with normal EF. The agreement between techniques for grading AR severity and assessing LV dilatation was poor, and CMR showed better reproducibility.
CMR improves the clinical efficacy of ultrasound for predicting outcomes of patients with AR. This is due to its better reproducibility and accuracy for grading the severity of the disease and its impact on the LV. Regurgitant fraction, LV ejection fraction, and end-diastolic volume obtained by CMR most adequately predict AR-related events.
慢性主动脉瓣反流（AR）手术时机的选择主要依赖于超声心动图。然而，心脏磁共振成像（CMR）在定量反流和左心室（LV）重构方面可能更准确。我们旨在比较超声心动图和CMR在评估疾病严重程度、LV重构程度及预测AR相关结局方面的技术和临床效果。
我们研究了263例连续接受超声心动图和CMR检查的孤立性AR患者。中位随访33个月后，197例初始无症状患者中有76例达到AR相关事件的主要终点：6例（3%）因心力衰竭入院，70例（36%）接受了手术。基于CMR的校正生存模型改善了基于超声心动图对主要终点的预测：R2 = 0.37对比0.22，χ2 = 97对比49（P < 0.0001），C指数 = 0.80对比0.70（P < 0.001）。这导致净分类指数为0.23（0.00 - 0.46，P = 0.046），综合辨别改善为0.12（95%置信区间0.08 - 0.58，P = 0.02）。CMR得出的反流分数（<28%、28% - 37%或>37%）和LV舒张末期容积（<83 mL、83 - 236 mL或>236 mL）对射血分数正常的患者进行了充分分层。评估AR严重程度和LV扩张的技术之间一致性较差，CMR显示出更好的可重复性。
CMR提高了超声预测AR患者结局的临床效果。这是由于其在疾病严重程度分级及其对LV的影响方面具有更好的可重复性和准确性。CMR获得的反流分数、LV射血分数和舒张末期容积最能充分预测AR相关事件。
