Quantification of pulmonary regurgitation and prediction of pulmonary valve replacement by echocardiography in patients with congenital heart defects in comparison to cardiac magnetic resonance imaging

Int J Cardiovasc Imaging. 2018 Apr;34(4):607-613. doi: 10.1007/s10554-017-1267-z. Epub 2017 Nov 8.


Pulmonary regurgitation (PR) is common in patients with congenital heart defects (CHD) and contributes to morbidity and mortality in the long-term. We investigated in this retrospective analysis whether readily accessible echocardiographic parameters are useful for quantification of PR and for predicting pulmonary valve replacement (PVR) in comparison to the gold-standard phase contrast (PC) flow measurements from cardiovascular magnetic resonance (CMR). Continuous wave (CW) Doppler and colour flow images in echocardiograms from 53 patients with CHD were analysed. Slope and jet-to-RVOT ratio correlated significantly with CMR-assessed regurgitation fraction (RF), whereas pressure half time (PHT) showed an inverse correlation. Patients with mild PR in CMR had significantly higher PHT, lower slope and jet-to-RVOT ratio than patients with moderate or severe regurgitation. The AUC regarding PR severity was 0.778 for PHT (95% CI, 0.649-0.907; P = 0.007 for CMR-RF ≤ 35%), 0.744 for slope (95% CI, 0.603-0.885; P = 0.017 for CMR-RF > 35%) and 0.652 for jet-to-RVOT ratio (95% CI, 0.473-0.860; P = 0.168 for CMR-RF > 35%). The optimal cut-off values calculated from ROC analysis were 95 ms for PHT and 4.9 m/s2 for slope. In logistic regression analysis, slope emerged as the most valuable parameter for predicting the indication for PVR (OR 12.9, 95% CI, 1.8-90.9, P = 0.010). In conclusion, echocardiographic assessment of PR was feasible. Both parameters, PHT and in particular slope, were predictors for PVR. Thus, echocardiography appears appropriate in the management of patients with PR.

Keywords: Cardiovascular magnetic resonance; Congenital heart disease; Echocardiography; Pulmonary regurgitation; Pulmonary valve replacement.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Area Under Curve
  • Disease Progression
  • Echocardiography, Doppler, Color*
  • Female
  • Heart Defects, Congenital / complications*
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / physiopathology
  • Heart Valve Prosthesis Implantation*
  • Humans
  • Logistic Models
  • Magnetic Resonance Imaging*
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Predictive Value of Tests
  • Pulmonary Valve / diagnostic imaging*
  • Pulmonary Valve / physiopathology
  • Pulmonary Valve / surgery
  • Pulmonary Valve Insufficiency / diagnostic imaging*
  • Pulmonary Valve Insufficiency / etiology
  • Pulmonary Valve Insufficiency / physiopathology
  • Pulmonary Valve Insufficiency / surgery
  • ROC Curve
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Young Adult