Erhebung echokardiographischer Parameter zur Quantifizierung der Pulmonalklappeninsuffizienz und Vergleich zur Schweregradbeurteilung im MRT

by Laura Kammerer
Doctoral thesis
Date of Examination:2025-01-21
Date of issue:2025-01-17
Advisor:Prof. Dr. Claudia Dellas
Referee:Prof. Dr. Andreas Schuster
Referee:PD Dr. Ruben Evertz
Persistent Address: http://dx.doi.org/10.53846/goediss-10950

 

 

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Abstract

English

Pulmonary regurgitation (PR) is a common valvular disease in patients with congenital heart defects (CHD) and contributes to morbidity and mortality in the long-term. This retrospective analysis invastigated wether echocardiographic parameters are appropriate for quantification of PR. The study also investigated the prediction of pulmonary valve replacement (PVR), both in comparison to phase contrast (PC) flow measurements from cardiovascular magnetic resonance (CMR), as CMR has emerged as the the gold-standard for PR assessment. In this study continuous wave (CW) Doppler and colour flow images in echocardiographies 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 optimal cut-off values calculated from ROC analysis to differentiate severe from not-severe PR were 95 ms for PHT and 4.9 m/s2 for slope. The requirement of pulmonary valve replacement (PVR) due to PR was the clinical endpoint of this study. The calculated cut-off values (PHT 95 ms, slope 4.9 m/s2) were used to test the prognostic performance of PHT and slope regarding the indication for PVR. Univariate logistic regression revealed, that a reduced PHT below 95 ms or an elevated slope above 4.9 m/s2 were significantly associated with a 3.3- and 15.8-increased risk for PVR recommendation. Logistic regression analysis showed that 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 appears useful and appropriate in the management of patients with PR.
Keywords: Pulmonary regurgitation; congenital heart defects; echocardiography; cardiovascular magnetic resonance; pulmonary valve replacement
 
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