Abstract 19471: Holodiastolic Flow Reversal at the Descending Aorta is Neither Sensitive Nor Specific for Significant Aortic Regurgitation: a Phase Contrast Magnetic Resonance Study
Introduction: Holodiastolic flow reversal (HDR) measured at the descending aorta (DAO) has been used as a surrogate marker to identify significant aortic regurgitation using echocardiography.
Hypothesis: The purpose of this study is to determine if the presence of HDR correlates with the aortic valve regurgitant fraction (AVRF).
Methods: We retrospectively reviewed 167 CMR studies (64% male, 36% female) from January 2011 to May 2012 where velocity mapping was acquired at both the aortic valve and the DAO at the level of the diaphragm. Patients with coarctation of the aorta or single ventricle physiology were excluded from the study. Descending aortic velocity maps were checked for baseline offset using a static reference region. HDR was defined as flow reversal throughout diastole both before and after baseline correction. Significant aortic regurgitation was defined as an AVRF >10%.
Results: There were 145 patients (mean patient age was 14.1 ± 9.5 yrs) with an AVRF 20% (Group C) (Figure 1). Though the AVRF was significantly higher for HDR versus non-HDR pts (8.5 ± 14.2 vs 3.8 ± 6.6%, p=0.04), HDR was present in 32 Group A pts (22%). In comparison, 4 Group B pts (57%), and 7 Group C pts (47%) had HDR. Of the 64 Group A pts with either Tetralogy of Fallot (48) or Transposition (16), 15 pts (23%) had HDR. The sensitivity of HDR to predict the combined Groups B & C
was 0.5, and the specificity for Group A was 0.78.
Conclusions: DAO HDR is neither a very sensitive nor specific finding for predicting significant aortic regurgitation. HDR in the absence of significant aortic regurgitation appears to be a relatively common finding, especially in patients with repaired conotruncal anomalies. HDR should be interpreted with caution when evaluating aortic insufficiency, and likely has no role in the pediatric and young adult population or in patients after repair of conotruncal anomalies.
Author Disclosures: M.A. Harris: None. M.A. Fogel: None. D.W. Kim: None. T.S. Kim: None. J.D. Rose: None. M.S. Keller: None. G.L. Fu: None. K.K. Whitehead: None.
- © 2014 by American Heart Association, Inc.