EACVI survey on evaluation and quantification of aortic regurgitation by multi-modality imaging

Sanjeev Bhattacharyya^{1

2

3}, Simona Beatrice Botezatu⁴, Giulia Elena Mandoli⁵, Giulia Vinco⁶, Tor Biering-Sørensen^{7

8

9

10}, Robert Manka^{11

12

13}, Emmanuel Androulakis¹⁴, Jose Rodriguez-Palomares¹⁵, Jadranka Separovic Hanzevacki¹⁶, Jolien Geers¹⁷, Maria Lembo¹⁸, Anna Baritussio¹⁹, Tomaž Podlesnikar^{20

21}, Marc R Dweck²²

Affiliations

¹ Echocardiography Laboratory, St Bartholomew's Hospital, London, UK.
² Cleveland Clinic London, London, UK.
³ William Harvey Research Institute, Queen Mary University of London, London, UK.
⁴ Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Bucharest, Romania.
⁵ Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy.
⁶ Department of Cardiology, Verona Integrated University Hospital, Verona, Italy.
⁷ Department of Biomedical Sciences, Faculty of Health and Medical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, University of Copenhagen, Copenhagen, Denmark.
⁸ Department of Cardiology, Cardiovascular Non-Invasive Imaging Research Laboratory, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
⁹ Steno Diabetes Center, Copenhagen, Denmark.
¹⁰ Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
¹¹ Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹² Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹³ Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
¹⁴ King's College Hospital, NHS Foundation Trust, London, United Kingdom.
¹⁵ Department of Cardiology, Hospital General Universitario Vall Hebrón, Barcelona, Spain.
¹⁶ Department of Cardiovascular Diseases Clinical Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.
¹⁷ University Hospital Brussels, Centre for Cardiovascular Diseases, Brussels, Belgium.
¹⁸ Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
¹⁹ Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiology, University Hospital, Padua, Italy.
²⁰ Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia.
²¹ Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
²² British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.

PMID: 40584918
PMCID: PMC12204183
DOI: 10.1093/ehjimp/qyaf058

EACVI survey on evaluation and quantification of aortic regurgitation by multi-modality imaging

Sanjeev Bhattacharyya et al. Eur Heart J Imaging Methods Pract. 2025.

. 2025 Jun 27;3(1):qyaf058.

doi: 10.1093/ehjimp/qyaf058. eCollection 2025 Jan.

Authors

Affiliations

¹ Echocardiography Laboratory, St Bartholomew's Hospital, London, UK.
² Cleveland Clinic London, London, UK.
³ William Harvey Research Institute, Queen Mary University of London, London, UK.
⁴ Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Bucharest, Romania.
⁵ Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy.
⁶ Department of Cardiology, Verona Integrated University Hospital, Verona, Italy.
⁷ Department of Biomedical Sciences, Faculty of Health and Medical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, University of Copenhagen, Copenhagen, Denmark.
⁸ Department of Cardiology, Cardiovascular Non-Invasive Imaging Research Laboratory, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
⁹ Steno Diabetes Center, Copenhagen, Denmark.
¹⁰ Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
¹¹ Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹² Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹³ Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
¹⁴ King's College Hospital, NHS Foundation Trust, London, United Kingdom.
¹⁵ Department of Cardiology, Hospital General Universitario Vall Hebrón, Barcelona, Spain.
¹⁶ Department of Cardiovascular Diseases Clinical Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.
¹⁷ University Hospital Brussels, Centre for Cardiovascular Diseases, Brussels, Belgium.
¹⁸ Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
¹⁹ Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiology, University Hospital, Padua, Italy.
²⁰ Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia.
²¹ Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
²² British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.

PMID: 40584918
PMCID: PMC12204183
DOI: 10.1093/ehjimp/qyaf058

Abstract

Aims: To investigate the real-world, current clinical practice of the assessment and management of aortic regurgitation (AR).

Methods and results: An electronic survey was distributed to cardiovascular imaging specialists by the European Society Association of Cardiovascular Imaging Scientific Initiatives Committee. Three hundred respondents from 66 countries completed the survey. In patients where initial qualitative evaluation suggested moderate AR, regurgitation severity was further characterized using vena contracta in 83%, pressure half-time in 70%, jet width/outflow tract diameter in 59%, regurgitant volume/effective orifice area 57% and three-dimensional vena contract in 20% of respondents. Cardiac magnetic resonance (CMR) was used by 72% of respondents when transthoracic echocardiographic (TTE) image quality was poor and 74% of respondents when there was discordance between Doppler findings and ventricular assessments. CMR 4-dimensional flow was performed by 19% of respondents. Left ventricular (LV) diameters were measured at the mitral valve level by 52% and at the mid LV by 43% of respondents. LV volumes were measured using TTE by 70%, with CMR by 40% and with CT by 2% of respondents.

Conclusion: There is heterogeneity in the echocardiographic methods used to quantify AR. The vena-contracta is the most commonly used for assessment of AR severity with relative underutilisation of quantitative methods. CMR is widely used to assess AR severity when echocardiographic assessments are uncertain. There is variation in the anatomical location to measure LV dilatation and variable use of LV volumes which may impact decision making for intervention.

Keywords: aortic regurgitation; cardiac magnetic resonance; echocardiography; left ventricle; quantification; remodelling.

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Conflict of interest statement

Conflict of interest: All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Graphical Abstract**
AR, aortic regurgitation; CMR, cardiac magnetic resonance; LV, left ventricle; LVOT, left ventricular outflow tract; TTE, transthoracic echocardiogram.

**Figure 1**
Proportion of respondents who used each different echocardiographic methods to quantify AR according to initial qualitative evaluation.

**Figure 2**
Proportion of respondents who use each different methods to quantify LV dilatation.

See this image and copyright information in PMC

References

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EACVI survey on evaluation and quantification of aortic regurgitation by multi-modality imaging

Affiliations

EACVI survey on evaluation and quantification of aortic regurgitation by multi-modality imaging

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials