Imaging Methods for Evaluation of Chronic Aortic Regurgitation in Adults: JACC State-of-the-Art Review.

A global multidisciplinary workshop was convened to discuss the multimodality diagnostic evaluation of aortic regurgitation (AR). Specifically, the focus was on assessment tools for AR severity and analyzing evolving data on the optimal timing of aortic valve intervention. The key concepts from this expert panel are summarized as: 1) echocardiography is the primary imaging modality for assessment of AR severity; however, when data is incongruent or incomplete, cardiac magnetic resonance may be helpful; 2) assessment of left ventricular size and function is crucial in determining the timing of intervention; 3) recent evidence suggests current cutpoints for intervention in asymptomatic severe AR patients requires further scrutiny; 4) left ventricular end-systolic volume index has emerged as an additional parameter that has promise in guiding timing of intervention; and 5) the role of additional factors (including global longitudinal strain, regurgitant fraction, and myocardial extracellular volume) is worthy of future investigation. [Display omitted] • Assessing the hemodynamic impact of AR on the LV involves integrating various imaging parameters pertaining to LV size and systolic function to determine the optimum time for intervention. • Conventional criteria for surgical intervention in patients with AR include: LVEF ≤55%, LVESD ≥25 mm/m2, progressive decline in LVEF to 55% to 60%, or increase in LVEDD to >65 mm. • Additional studies are needed to determine whether lower thresholds (eg, LVEF <60% and LVESD >20 mm/m2) for valve intervention would improve long-term outcomes for patients with chronic, severe AR. [ABSTRACT FROM AUTHOR]