Abstract 3123: Doppler Echocardiography Reliably Predicts Severe Pulmonary Regurgitation (PR) As Quantified by Cardiac Magnetic Resonance (CMR)
Background: Significant PR is a common sequel to repair of some forms of congenital heart disease (CHD). Grading the severity of PR by Doppler echocardiography (echo-Doppler) is not standardized and may be problematic. CMR is considered the gold standard method for quantifying PR, but is not universally available. We sought to determine the best echo-Doppler predictors of severe PR.
Methods & Results: We retrospectively reviewed 36 CHD pts (median age 31 yrs, range 10 – 67 yrs; 33 with Tetralogy of Fallot, 3 with primary pulmonary stenosis) with prior pulmonary valvuloplasty and/or transannular patch placement who underwent both Doppler echo and velocity encoded CMR. Severe CMR PR was defined as ≥40% regurgitant fraction. Echo-Doppler measurements used to predict severe PR were: diastolic flow reversal (DFR) of color flow or spectral pulsed wave Doppler in the main pulmonary artery (MPA) or the branch pulmonary arteries (BPA), a PR jet that fills ≥50% of the pulmonary annular diameter (PAD), PR pressure half-time (PHT) <100 msec, & pulmonary regurgitation index (PRi) <0.77. MPA DFR had 100% sensitivity but low specificity (39%) for detecting severe PR (Table 1⇓). BPA DFR remained quite sensitive (87%), but much more specific (87%). Univariate analysis showed each variable (except PRi) was a good individual predictor of severe PR (Table 2⇓). Classification & regression tree analysis showed the 2 most useful variables were (first) DFR in the BPA & (second) the PRi <0.77.
Conclusions: Readily obtained targeted echo-Doppler measurements reliably identify severe PR as quantified by CMR. BPA DFR is the most specific and MPA DFR is the most sensitive echo-Doppler finding for detecting severe PR.