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.
BACKGROUND Consensus documents provide recommendations on using cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) in pulmonary valve replacement (PVR) planning in congenital heart disease (CHD). However, clinical practice patterns across institutions remain unclear, particularly with the increase in transcatheter PVR options and multi-modality imaging use. We aimed to characterize practice variation in cross-sectional imaging using CCT and CMR. METHODS A REDCap survey was distributed to Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography members to assess imaging practices for PVR planning in CHD, including imaging volumes, acquisition protocols, right ventricular outflow tract (RVOT) measurement techniques, and reporting times, with one response per institution. Wilcoxon rank sum tests, Fisher's exact tests, and analysis of variance were used. RESULTS Forty-three institutions (84% US and 16% international) responded. Most centers (29/43, 67%) reported performing CMR first, adding CCT only if the Harmony valve or Alterra pre-stent was under consideration. Only two centers (5%) used CCT without CMR as their standard practice. CCT was performed instead of CMR in patients with pacemakers or intracardiac leads (28/38, 74%). 88% of centers perform functional CCT, with 44% reporting ventricular volumes and function. Eight centers (19%) used a focused field of view on the RVOT, and branch pulmonary arteries, excluding the ventricles. RVOT measurement techniques varied: 84% of centers used angulated multiplanar reformats (MPR) and 28% used centerline technique/curved planar reformats (CPR). 88% used MPR-derived diameters and 24% used perimeter-derived area and average diameters. For CMR, only six centers (14%) reported using a non-gadolinium-based superparamagnetic iron oxide contrast agent. 30% of centers reported performing dedicated RVOT short-axis cine sequences and 16% reported utilizing 4D flow or 3D models. Median reporting times were 60minutes (IQR 60-90) for CCT and 120minutes (IQR 80-142) for CMR with dedicated technologist support available in 14 (33%) for CCT, and 15 (35%) for CMR. Overall, 84% favored a standardized imaging protocol and/or reporting template for PVR planning. CONCLUSION This survey highlights wide variations in imaging practices for PVR planning, with most respondents supporting standardization, which may improve efficiency, quality, and potentially reduce radiation burden in this specific patient population.
BACKGROUND Patients with major depressive disorder with anxious distress (MDD-A) frequently experience cardiovascular symptoms (CVS), which are associated with impaired quality of life and poorer long-term prognosis. This study aimed to quantitatively evaluate myocardial alterations in MDD-A patients using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) and mapping-derived entropy analysis, and to explore their associations with CVS as well as the severity of depressive and anxiety symptoms. METHODS In this prospective study, 58 consecutively enrolled medication-naïve patients with MDD-A diagnosed according to DSM-5 criteria and 61 healthy controls were included. All participants underwent CMR examinations at 3.0T. Left ventricular (LV) function, native T1 and T2 values, T1-entropy and T2-entropy, LV strain parameters, and oxygenation-sensitive signal intensity change (OS-SI%) were measured and compared between the two groups. Associations between CMR-derived parameters and CVS, anxiety symptom severity, and depressive symptom severity were assessed separately. A p value < 0.05 was considered statistically significant. RESULTS Compared with healthy controls, patients with MDD-A exhibited significantly higher T1-entropy (8.3 ± 0.3 vs. 7.5 ± 0.3, p < 0.001) and T2-entropy (9.2 ± 0.4 vs. 8.1 ± 0.3, p < 0.001), whereas OS-SI% was significantly lower (11.4 ± 7.5% vs. 14.5 ± 4.5%, p = 0.007). After adjustment for age, sex, smoking status, and heart rate, multivariable regression analyses revealed that OS-SI% was inversely associated with HAMD scores (β = -0.205, p = 0.043) and HAMA scores (β = -0.453, p < 0.001), and inversely associated with CVS (OR= 0.801, p = 0.002). T1-entropy (β = 4.105, p = 0.022) and T2-entropy (β = 2.793, p = 0.042) were positively associated with HAMD scores. CONCLUSION OS-SI% and mapping-derived myocardial entropy measures may serve as valuable noninvasive imaging biomarkers for assessing early myocardial alterations in patients with MDD-A.
