EACVI survey on evaluation and quantification of aortic regurgitation by multi-modality imaging

Aims: To investigate the real-world, current clinical practice of the assessment and management of aortic regurgitation (AR). Methods and results: An electronic survey was distributed to cardiovascular imaging specialists by the European Society Association of Cardiovascular Imaging Scientific Initiatives Committee. Three hundred respondents from 66 countries completed the survey. In patients where initial qualitative evaluation suggested moderate AR, regurgitation severity was further characterized using vena contracta in 83%, pressure half-time in 70%, jet width/outflow tract diameter in 59%, regurgitant volume/effective orifice area 57% and three-dimensional vena contract in 20% of respondents. Cardiac magnetic resonance (CMR) was used by 72% of respondents when transthoracic echocardiographic (TTE) image quality was poor and 74% of respondents when there was discordance between Doppler findings and ventricular assessments. CMR 4-dimensional flow was performed by 19% of respondents. Left ventricular (LV) diameters were measured at the mitral valve level by 52% and at the mid LV by 43% of respondents. LV volumes were measured using TTE by 70%, with CMR by 40% and with CT by 2% of respondents. Conclusion: There is heterogeneity in the echocardiographic methods used to quantify AR. The vena-contracta is the most commonly used for assessment of AR severity with relative underutilisation of quantitative methods. CMR is widely used to assess AR severity when echocardiographic assessments are uncertain. There is variation in the anatomical location to measure LV dilatation and variable use of LV volumes which may impact decision making for intervention.