Background

Reflux of the aortic regurgitation (AR) causes an increased diastolic reverse flow in the aorta and its branching vessels. We aimed to evaluate the feasibility and accuracy of Doppler measurements in the left subclavian artery (LSA) for quantification of AR in a cardiovascular magnetic resonance imaging (CMR) validation study.

Methods

Systolic and diastolic flow profiles of the LSA (subclavicular approach) were evaluated prospectively by use of pulsed wave Doppler in 59 patients (55.5 ± 15 years; 44 men), 47 with a wide spectrum of AR and 12 as control group. Using CMR phase-contrast sequences (performed 1 cm above the aortic valve), the AR was divided into three groups: mild, regurgitant fraction (RF) < 20% (n = 17); moderate, RF 20%-40% (n = 10); and severe, RF > 40% (n = 20). The LSA Doppler-derived RF was calculated as the ratio between diastolic and systolic velocity-time integrals (VTI).

Results

Quality LSA Doppler signal could be obtained in all cases. Patients with CMR severe AR had higher values of LSA Doppler-derived RF (51% ± 9% vs 36% ± 11% vs 16% ± 8%; P < .0001). LSA Doppler showed a good correlation with CMR, with a sensitivity of 95%, specificity of 89%, and diagnostic accuracy for severe AR of 91.5%. Finally, Bland-Altman plots showed agreement in the group with moderate to severe AR (mean bias = −2.2% ± 8%, 95% CI, −17.7 to 13.3; P = .145) but differed in mild AR.

Conclusions

Measurements of the RF for quantification of AR using LSA Doppler are comparable to those of CMR, highlighting the potential role of LSA Doppler as an adjunctive technique to assess the severity of AR.

中文翻译：

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左锁骨下动脉速度轮廓的脉冲多普勒检查定量主动脉瓣关闭不全：心血管磁共振成像的验证研究。

背景

主动脉反流（AR）的回流导致主动脉及其分支血管中舒张逆流的增加。我们旨在评估在心血管磁共振成像（CMR）验证研究中对左锁骨下动脉（LSA）进行多普勒测量以定量AR的可行性和准确性。

方法

LSA（锁骨下入路）的收缩和舒张血流曲线通过脉冲多普勒对59例患者（55.5±15岁； 44例男性），47例AR广泛的47例和12例作为对照组进行了前瞻性评估。使用CMR相衬序列（在主动脉瓣上方1 cm处进行），将AR分为三组：轻度，反流成分（RF）<20％（n  = 17）；反流率（RF）小于20％（n = 17）。中度，RF 20％-40％（n  = 10）; 严重时，RF> 40％（n  = 20）。LSA多普勒衍生的RF计算为舒张期与收缩期速度-时间积分（VTI）之比。

结果

在所有情况下都可以获得高质量的LSA多普勒信号。患有CMR严重AR的患者具有更高的LSA多普勒衍生RF值（51％±9％vs 36％±11％vs 16％±8％；P  <.0001）。LSA多普勒与CMR相关性良好，灵敏度为95％，特异性为89％，对严重AR的诊断准确性为91.5％。最后，Bland-Altman图显示中度至重度AR组的一致性（平均偏倚= -2.2％±8％，95％CI，-17.7至13.3；P  = .145），但轻度AR不同。

结论

使用LSA多普勒对RF进行的RF定量测量与CMR相当，从而突出了LSA多普勒作为评估AR严重程度的辅助技术的潜在作用。