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<p>Atrioventricular valve regurgitation (AVVR) remains a significant complication post-Fontan. This study evaluates the accuracy of 4D flow AVVR quantification in post-Fontan patients by comparing 4D flow to conventional echocardiographic (AVVR<sub>Echo</sub>) and CMR assessments. Patients in the multi-institutional FORCE registry with high-quality 4D flow CMR were included. Regurgitant fractions (RFs) were calculated using two 4D-flow based methods: AVVR<sub>AVV−Ao (4D)</sub>, calculated from atrioventricular valve and aortic flows, and AVVR<sub>Jet</sub>, which directly measures AVVR jet volume. 4D flow RFs and severity classifications were compared with AVVR<sub>Echo</sub> and CMR-reported AVVR severity (AVVR<sub>Report−Cat</sub>), and examiner-reported RFs (AVVR<sub>Report−RF</sub>). Statistical tests included Pearson correlation, Cohen’s kappa, and Bland-Altman analysis. The study included 218 post-Fontan patients (median age: 16.2 years, IQR: 12.8–22.5) and 36.2% were female. Both 4D flow methods displayed excellent interobserver reproducibility (interclass correlation &gt; 0.95) and RFs approximately 7% lower than AVVR<sub>Report−RF</sub>. AVVR<sub>AVV−Ao (4D)</sub> showed stronger agreement with AVVR<sub>Report−RF</sub> (κ = 0.50 [95% CI: 0.25–0.75]; <i>r</i> = 0.49, <i>p</i> &lt; 0.01). AVVR<sub>Jet</sub>​ demonstrated better concordance with AVVR<sub>Report−Cat</sub> (κ = 0.31 [95% CI: 0.17–0.45]). Both AVVR<sub>AVV−Ao (4D)</sub> (OR = 1.53, <i>p</i> = 0.004; AUC = 0.71) and AVVR<sub>Jet</sub> (OR = 1.74, <i>p</i> = 0.002; AUC = 0.65) were associated significantly with the composite outcome of death and heart transplantation listing. This is the first study analyzing the accuracy of 4D flow AVVR quantification in post-Fontan patients, demonstrating reproducibility, prognostic value, and good concordance with conventional methods. These findings suggest that 4D flow AVVR quantification may serve as a complementary method for assessing AVVR in post-Fontan patients.</p>

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Measuring Atrioventricular Valve Regurgitation Using 4D Flow Cardiovascular Magnetic Resonance Post-Fontan

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月7日

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  • Husayn M. Ladha,
  • Justin C. Wang,
  • Yu Li,
  • Adam B. Christopher,
  • Jacqueline Kreutzer,
  • Rajesh Krishnamurthy,
  • Francesca Raimondi,
  • Joshua D. Robinson,
  • Yue-Hin Loke,
  • Laura J. Olivieri,
  • Mark A. Fogel,
  • Rafael Ceschin,
  • Rahul H. Rathod,
  • Tarek Alsaied,
  • M. Aggarwal,
  • T. Alsaied,
  • J. Detterich,
  • A. L. Dorfman,
  • A. Doshi,
  • M. D. Files,
  • M. Fogel,
  • J. Gerardin,
  • S. Hegde,
  • A. Hoyer,
  • T. Johnson,
  • A. M. Kelle,
  • R. Krishnamurthy,
  • C. Z. Lam,
  • Y. Loke,
  • A. L. Marsden,
  • V. Muthurangu,
  • L. J. Olivieri,
  • M. Quail,
  • F. Raimondi,
  • P. Ramachandran,
  • R. H. Rathod,
  • P. Renella,
  • M. S. Renno,
  • J. D. Robinson,
  • G. Ruchira,
  • A. Shah,
  • T. C. Slesnick,
  • J. H. Soslow,
  • J. Steele,
  • K. W. Stern,
  • B. Thattaliyath,
  • A. Vaikom House,
  • A. van Deutekom,
  • J. Weigand

摘要

Atrioventricular valve regurgitation (AVVR) remains a significant complication post-Fontan. This study evaluates the accuracy of 4D flow AVVR quantification in post-Fontan patients by comparing 4D flow to conventional echocardiographic (AVVREcho) and CMR assessments. Patients in the multi-institutional FORCE registry with high-quality 4D flow CMR were included. Regurgitant fractions (RFs) were calculated using two 4D-flow based methods: AVVRAVV−Ao (4D), calculated from atrioventricular valve and aortic flows, and AVVRJet, which directly measures AVVR jet volume. 4D flow RFs and severity classifications were compared with AVVREcho and CMR-reported AVVR severity (AVVRReport−Cat), and examiner-reported RFs (AVVRReport−RF). Statistical tests included Pearson correlation, Cohen’s kappa, and Bland-Altman analysis. The study included 218 post-Fontan patients (median age: 16.2 years, IQR: 12.8–22.5) and 36.2% were female. Both 4D flow methods displayed excellent interobserver reproducibility (interclass correlation > 0.95) and RFs approximately 7% lower than AVVRReport−RF. AVVRAVV−Ao (4D) showed stronger agreement with AVVRReport−RF (κ = 0.50 [95% CI: 0.25–0.75]; r = 0.49, p < 0.01). AVVRJet​ demonstrated better concordance with AVVRReport−Cat (κ = 0.31 [95% CI: 0.17–0.45]). Both AVVRAVV−Ao (4D) (OR = 1.53, p = 0.004; AUC = 0.71) and AVVRJet (OR = 1.74, p = 0.002; AUC = 0.65) were associated significantly with the composite outcome of death and heart transplantation listing. This is the first study analyzing the accuracy of 4D flow AVVR quantification in post-Fontan patients, demonstrating reproducibility, prognostic value, and good concordance with conventional methods. These findings suggest that 4D flow AVVR quantification may serve as a complementary method for assessing AVVR in post-Fontan patients.