Quantitative cardiac MRI assessment of aortic regurgitation and reverse remodeling after surgery: a multi-center study

Cardiac magnetic resonance (CMR) quantifies aortic regurgitation (AR) and left ventricular (LV) remodeling. We aimed to evaluate the association of baseline CMR findings with reverse remodeling after aortic valve surgery and likelihood of normalization of LV volume/function is not clear. In a multicenter observational study of AR patients undergoing pre- and post-operative CMR, we evaluated AR severity and LV volumes on baseline CMR with reverse remodeling evaluated by LV volumes and function after surgery. We identified chronic AR patients enrolled in institutional databases at 3 centers between 2011 and 2022 with pre- and post-operative CMR. We also prospectively enrolled patients with AR and preop CMR to undergo a research CMR post-operatively at Houston Methodist Hospital during the year 2021. We studied 55 patients in total (17 enrolled prospectively), median age 57.0 (45.4–64.2) years, 87% male. Median AR fraction was 42.5% (38.0–51.0). Patients underwent surgery at a median 48 days [25–107] after CMR. Follow up CMR was performed a median of 2.56 years [1.03–3.98] after surgery. Post operatively, there was significant decrease in LV end-diastolic volume (LVEDV) (mean decrease 115.9 ± 93.7 ml), LV end-systolic volume (LVESV), and LV mass; and increase in LV ejection fraction (mean increase 5.6 ± 9.1%) all P ≤ 0.001. Baseline regurgitant volume (RVol) was positively associated with reduction in LVEDV after surgery (r = 0.52, P < 0.001). Patients who had < 30 ml reduction in Rvol between baseline and follow up scans (due to lower Rvol at baseline or residual AR post-surgery) had significantly lower reduction of LVEDV between studies (mean decrease 57.8 ± 72.3 ml vs. 130.5 ± 93.6 ml in patients with RVol reduction > 30 ml, P = 0.01). In patients with > 1 year follow up CMR studies, ROC analysis showed baseline indexed LVESV to have the highest AUC for the association of LV volume & function normalization post operatively, (AUC = 0.72, P = 0.04). Quantitation of AR severity by CMR is associated with extent of positive remodeling after surgery. Preoperative indexed LV end-systolic volume by CMR was most associated with normalization of LV volume and systolic function > 1 year after surgery.