Valvular & structural heart diseaseDiagnostic or prognostic study
Optimization of echocardiographic quantification of aortic regurgitation against cardiac magnetic resonance (CMR): novel algorithm development and prospective validation
- novel algorithm development and prospective validation
- historical derivation cohort
- prospective validation cohort
- decision tree regression
Authors' conclusion
Novel TTEs algorithm increased TTE accuracy of identifying significant AR defined by CMR especially in the prospective cohort, compared to the current guidelines criteria, and was able to modestly discriminate LV remodelling.
Study context
- Population
- Patients with moderate-to-severe aortic regurgitation (AR) undergoing both TTE and CMR within 3-monthshistorical derivation cohort 2006-18 193 · prospective validation cohort 2019-21 97
- Participants
- 193 vs 97
- Comparison
- novel algorithms (proximal isovelocity surface area and Doppler methods) compared with current guidelines criteria for detecting CMR-derived severe AR
- Historical derivation cohortn = 193
- Prospective validation cohortn = 97
Performance
As reported in the abstract
Mean AR regurgitant volumes, fractions, and proportions with HDR by TTE/CMR
| Test or model | Regurgitant volume TTE/CMR | Regurgitant fraction TTE/CMR | Proportion with HDR TTE/CMR |
|---|---|---|---|
| Historical derivation cohort | 48/31 mL | 41/25% | 43%/27% |
| Prospective validation cohort | 51/37 mL | 47/29% | 54%/41% |
Further findings
| Outcome | Historical derivation cohort | Prospective validation cohort |
|---|---|---|
| AUC for detecting CMR-derived severe AR | ||
| Novel algorithm, PISA | 0.80 (0.71-0.88) | 0.76 (0.66-0.87) |
| Novel algorithm, Doppler | 0.74 (0.65-0.83) | 0.71 (0.61-0.82) |
| Current guidelines criteria | 0.72 (0.63-0.81) | 0.58 (0.46-0.70) |
- AUC for detecting CMR-derived severe AR: 95%CIs
TTE thresholds best identifying CMR-derived severe AR (decision-tree analyses)
- regurgitant volume
- ≥ 45 mL
- Left ventricular end-diastolic volume index (LVEDVi)
- ≥ 93 mL/m²
AUC for predicting left ventricular remodelling where follow-up TTE was available
- Novel algorithm, PISA
- 0.65 (0.58-0.73)
- Novel algorithm, Doppler
- 0.62 (0.55-0.70)
- Current guidelines criteria
- 0.53 (0.45-0.61)
- 95%CIs
Original publication
Optimization of echocardiographic quantification of aortic regurgitation against CMR: novel algorithm development and prospective validation. Eur Heart J Cardiovasc Imaging. Published 20 January 2026. doi:10.1093/ehjci/jeag012
Summarised from the published abstract; every number is checked against it