Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2026
Measuring atrioventricular valve regurgitation in Fontan patients using cardiovascular magnetic resonance imaging and the association with clinical outcomes: A FORCE Study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Li Yu, Schiff Mary, Olivieri Laura J, Muthurangu Vivek, Yao Tina, Christopher Adam B, Liddle David W, Morell Victor, Castro-Medina Mario, Fogel Mark A, Loke Yue-Hin, Kreutzer Jacqueline, Rathod Rahul H, Alsaied Tarek, FORCE Investigators
Аннотация
BACKGROUND: Atrioventricular valve regurgitation (AVVR) predicts long-term post-Fontan adverse outcomes. Literature on the measurement and prognostic value of quantitative AVVR assessment using cardiovascular magnetic resonance imaging (CMR) is limited. This study compared echocardiographic AVVR measurements with measurements by CMR, and investigated their association with clinical outcomes using the multi-center Fontan Outcome Registry using Clinical Examination (FORCE).
METHODS: Patients with an examiner-reported AVVR severity category from CMR (AVVRReport-Cat) and an AVVR from matched echocardiography (AVVREcho) were included. Three quantitative CMR AVVR regurgitant fractions were used as follows: (1) stroke volume and antegrade aortic flow (AVVRStandard), (2) atrioventricular valve flow and antegrade aortic flow (AVVRAVV-AO), and (3) examiner-reported regurgitation fraction (AVVRReport-RF). Moderate AVVR was defined as regurgitant fraction of 20%-40% and severe >40%. The concordance across methods was calculated using Kappa statistics, and associations with outcomes of mortality or listing for/receiving heart transplantation were analyzed using Cox proportional hazard models. C-statistic was used to compare model performance.
RESULTS: Exactly 2309 Fontan patients were included, with a median age at CMR of 15.7 years and (971/2309) 42.1% female. Categorical AVVR severity reported by CMR was significantly associated with adverse outcomes (adjusted HR 2.10, 95% CI [1.38, 3.19] for moderate and 4.61 [2.80, 7.58] for severe AVVR), comparable to AVVR reported by echocardiography. AVVRAVV-AO showed stronger concordance with AVVRReport-Cat (Kappa=0.58) and higher hazards of the adverse outcome than AVVRStandard. The subset of patients with examiner-reported regurgitation fraction (AVVRReport-RF) showed the highest hazard associated with AVVR and the highest C-statistic among all methods including echocardiography.
CONCLUSIONS: This is the first study evaluating different CMR measurements of AVVR in a large cohort of Fontan patients. Compared with AVVRStandard, AVVRAVV-AO had higher concordance with the reported categorical AVVR using CMR. Moderate and severe AVVR determined by both CMR and echocardiography were associated with comparably increased hazards of adverse clinical outcomes.
METHODS: Patients with an examiner-reported AVVR severity category from CMR (AVVRReport-Cat) and an AVVR from matched echocardiography (AVVREcho) were included. Three quantitative CMR AVVR regurgitant fractions were used as follows: (1) stroke volume and antegrade aortic flow (AVVRStandard), (2) atrioventricular valve flow and antegrade aortic flow (AVVRAVV-AO), and (3) examiner-reported regurgitation fraction (AVVRReport-RF). Moderate AVVR was defined as regurgitant fraction of 20%-40% and severe >40%. The concordance across methods was calculated using Kappa statistics, and associations with outcomes of mortality or listing for/receiving heart transplantation were analyzed using Cox proportional hazard models. C-statistic was used to compare model performance.
RESULTS: Exactly 2309 Fontan patients were included, with a median age at CMR of 15.7 years and (971/2309) 42.1% female. Categorical AVVR severity reported by CMR was significantly associated with adverse outcomes (adjusted HR 2.10, 95% CI [1.38, 3.19] for moderate and 4.61 [2.80, 7.58] for severe AVVR), comparable to AVVR reported by echocardiography. AVVRAVV-AO showed stronger concordance with AVVRReport-Cat (Kappa=0.58) and higher hazards of the adverse outcome than AVVRStandard. The subset of patients with examiner-reported regurgitation fraction (AVVRReport-RF) showed the highest hazard associated with AVVR and the highest C-statistic among all methods including echocardiography.
CONCLUSIONS: This is the first study evaluating different CMR measurements of AVVR in a large cohort of Fontan patients. Compared with AVVRStandard, AVVRAVV-AO had higher concordance with the reported categorical AVVR using CMR. Moderate and severe AVVR determined by both CMR and echocardiography were associated with comparably increased hazards of adverse clinical outcomes.