Prognostic Value of Cardiovascular MRI in Asymptomatic Patients with Moderate-to-Severe Aortic Regurgitation: A Network Meta-Analysis

Stefano Figliozzi; Kamil Stankowski; Silvana Di Maio; Konstantinos Pateras; Thanakorn Rojanathagoon; Oksana Marchenko; Vasileios Stylianidis; Marco Francone; Lorenzo Monti; João L Cavalcante; Georgios Georgiopoulos; Pier Giorgio Masci

doi:10.1148/ryct.240313

Prognostic Value of Cardiovascular MRI in Asymptomatic Patients with Moderate-to-Severe Aortic Regurgitation: A Network Meta-Analysis

Stefano Figliozzi
, Kamil Stankowski
, Silvana Di Maio
, Konstantinos Pateras
, Thanakorn Rojanathagoon
, Oksana Marchenko
, Vasileios Stylianidis
, Marco Francone
, Lorenzo Monti
, João L Cavalcante
, Georgios Georgiopoulos
, Pier Giorgio Masci

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Purpose: To determine the prognostic significance of cardiac MRI parameters in patients with moderate-to-severe aortic regurgitation (AR) and minimal or no symptoms through a network meta-analysis. Materials and Methods: This systematic review and network meta-analysis searched in PubMed, Embase, and Cochrane Library databases for articles published from January 1, 2000, to March 1, 2024, investigating the prognostic value of cardiac MRI parameters in patients with moderate-to-severe AR. The composite outcome included all-cause death, heart failure hospitalization, aortic valve replacement, new-onset heart failure symptoms, New York Heart Association class progression, and left ventricular ejection fraction less than 50%. Both pairwise and network meta-analyses were performed. Results: Eight studies with 1579 patients (1187 male patients [75%]; mean age, 55 years ± 5 [SD]) were included. Aortic regurgitant volume and regurgitant fraction were associated with a higher incidence of adverse events (pooled hazard ratio [HR], 1.04 per 1 mL increase [95% CI: 1.01, 1.06] and pooled HR, 1.09 per 1% increase [95% CI: 1.03, 1.16], respectively). Adverse remodeling, reflected by increased end-diastolic or end-systolic volume (pooled HR, 1.02 per 1 mL/m ² [95% CI: 1.01, 1.03] and pooled HR, 1.02 per 1 mL/m ² [95% CI: 1.01, 1.04], respectively), was predictive of worse outcome. Late gadolinium enhancement was associated with a twofold increased risk of developing the study end point (pooled HR, 1.86; 95% CI: 1.20, 2.89). T1 mapping and extracellular volume could not be assessed. Network meta-analysis disclosed that late gadolinium enhancement (P =.884) and regurgitant fraction (P =.727) were the most important prognostic factors. Conclusion: This network meta-analysis demonstrated the strong prognostic value of regurgitant fraction and left ventricular adverse remodeling as assessed with cardiac MRI in risk stratification of patients with moderate-to-severe AR and no or minimal symptoms.

Original language	English
Article number	e240313
Journal	Radiology: Cardiothoracic Imaging
Volume	7
Issue number	3
Early online date	20 Jun 2025
DOIs	https://doi.org/10.1148/ryct.240313
Publication status	E-pub ahead of print - 20 Jun 2025

Keywords

Humans
Male
Middle Aged
Aortic Valve Insufficiency/diagnostic imaging
Magnetic Resonance Imaging/methods
Prognosis
Severity of Illness Index

Access to Document

10.1148/ryct.240313

Cite this

Figliozzi, S., Stankowski, K., Di Maio, S., Pateras, K., Rojanathagoon, T., Marchenko, O., Stylianidis, V., Francone, M., Monti, L., Cavalcante, J. L., Georgiopoulos, G., & Masci, P. G. (2025). Prognostic Value of Cardiovascular MRI in Asymptomatic Patients with Moderate-to-Severe Aortic Regurgitation: A Network Meta-Analysis. Radiology: Cardiothoracic Imaging, 7(3), Article e240313. Advance online publication. https://doi.org/10.1148/ryct.240313

@article{91742405e1394e0b86921f0579df4bb5,

title = "Prognostic Value of Cardiovascular MRI in Asymptomatic Patients with Moderate-to-Severe Aortic Regurgitation: A Network Meta-Analysis",

abstract = "Purpose: To determine the prognostic significance of cardiac MRI parameters in patients with moderate-to-severe aortic regurgitation (AR) and minimal or no symptoms through a network meta-analysis. Materials and Methods: This systematic review and network meta-analysis searched in PubMed, Embase, and Cochrane Library databases for articles published from January 1, 2000, to March 1, 2024, investigating the prognostic value of cardiac MRI parameters in patients with moderate-to-severe AR. The composite outcome included all-cause death, heart failure hospitalization, aortic valve replacement, new-onset heart failure symptoms, New York Heart Association class progression, and left ventricular ejection fraction less than 50\%. Both pairwise and network meta-analyses were performed. Results: Eight studies with 1579 patients (1187 male patients [75\%]; mean age, 55 years ± 5 [SD]) were included. Aortic regurgitant volume and regurgitant fraction were associated with a higher incidence of adverse events (pooled hazard ratio [HR], 1.04 per 1 mL increase [95\% CI: 1.01, 1.06] and pooled HR, 1.09 per 1\% increase [95\% CI: 1.03, 1.16], respectively). Adverse remodeling, reflected by increased end-diastolic or end-systolic volume (pooled HR, 1.02 per 1 mL/m 2 [95\% CI: 1.01, 1.03] and pooled HR, 1.02 per 1 mL/m 2 [95\% CI: 1.01, 1.04], respectively), was predictive of worse outcome. Late gadolinium enhancement was associated with a twofold increased risk of developing the study end point (pooled HR, 1.86; 95\% CI: 1.20, 2.89). T1 mapping and extracellular volume could not be assessed. Network meta-analysis disclosed that late gadolinium enhancement (P =.884) and regurgitant fraction (P =.727) were the most important prognostic factors. Conclusion: This network meta-analysis demonstrated the strong prognostic value of regurgitant fraction and left ventricular adverse remodeling as assessed with cardiac MRI in risk stratification of patients with moderate-to-severe AR and no or minimal symptoms.",

keywords = "Humans, Male, Middle Aged, Aortic Valve Insufficiency/diagnostic imaging, Magnetic Resonance Imaging/methods, Prognosis, Severity of Illness Index",

author = "Stefano Figliozzi and Kamil Stankowski and \{Di Maio\}, Silvana and Konstantinos Pateras and Thanakorn Rojanathagoon and Oksana Marchenko and Vasileios Stylianidis and Marco Francone and Lorenzo Monti and Cavalcante, \{Jo{\~a}o L\} and Georgios Georgiopoulos and Masci, \{Pier Giorgio\}",

note = "Publisher Copyright: {\textcopyright} RSNA, 2025.",

year = "2025",

month = jun,

day = "20",

doi = "10.1148/ryct.240313",

language = "English",

volume = "7",

journal = "Radiology: Cardiothoracic Imaging",

issn = "2638-6135",

publisher = "Radiological Society of North America Inc.",

number = "3",

}

Figliozzi, S, Stankowski, K, Di Maio, S, Pateras, K, Rojanathagoon, T, Marchenko, O, Stylianidis, V, Francone, M, Monti, L, Cavalcante, JL, Georgiopoulos, G & Masci, PG 2025, 'Prognostic Value of Cardiovascular MRI in Asymptomatic Patients with Moderate-to-Severe Aortic Regurgitation: A Network Meta-Analysis', Radiology: Cardiothoracic Imaging, vol. 7, no. 3, e240313. https://doi.org/10.1148/ryct.240313

TY - JOUR

T1 - Prognostic Value of Cardiovascular MRI in Asymptomatic Patients with Moderate-to-Severe Aortic Regurgitation

T2 - A Network Meta-Analysis

AU - Figliozzi, Stefano

AU - Stankowski, Kamil

AU - Di Maio, Silvana

AU - Pateras, Konstantinos

AU - Rojanathagoon, Thanakorn

AU - Marchenko, Oksana

AU - Stylianidis, Vasileios

AU - Francone, Marco

AU - Monti, Lorenzo

AU - Cavalcante, João L

AU - Georgiopoulos, Georgios

AU - Masci, Pier Giorgio

N1 - Publisher Copyright: © RSNA, 2025.

PY - 2025/6/20

Y1 - 2025/6/20

N2 - Purpose: To determine the prognostic significance of cardiac MRI parameters in patients with moderate-to-severe aortic regurgitation (AR) and minimal or no symptoms through a network meta-analysis. Materials and Methods: This systematic review and network meta-analysis searched in PubMed, Embase, and Cochrane Library databases for articles published from January 1, 2000, to March 1, 2024, investigating the prognostic value of cardiac MRI parameters in patients with moderate-to-severe AR. The composite outcome included all-cause death, heart failure hospitalization, aortic valve replacement, new-onset heart failure symptoms, New York Heart Association class progression, and left ventricular ejection fraction less than 50%. Both pairwise and network meta-analyses were performed. Results: Eight studies with 1579 patients (1187 male patients [75%]; mean age, 55 years ± 5 [SD]) were included. Aortic regurgitant volume and regurgitant fraction were associated with a higher incidence of adverse events (pooled hazard ratio [HR], 1.04 per 1 mL increase [95% CI: 1.01, 1.06] and pooled HR, 1.09 per 1% increase [95% CI: 1.03, 1.16], respectively). Adverse remodeling, reflected by increased end-diastolic or end-systolic volume (pooled HR, 1.02 per 1 mL/m 2 [95% CI: 1.01, 1.03] and pooled HR, 1.02 per 1 mL/m 2 [95% CI: 1.01, 1.04], respectively), was predictive of worse outcome. Late gadolinium enhancement was associated with a twofold increased risk of developing the study end point (pooled HR, 1.86; 95% CI: 1.20, 2.89). T1 mapping and extracellular volume could not be assessed. Network meta-analysis disclosed that late gadolinium enhancement (P =.884) and regurgitant fraction (P =.727) were the most important prognostic factors. Conclusion: This network meta-analysis demonstrated the strong prognostic value of regurgitant fraction and left ventricular adverse remodeling as assessed with cardiac MRI in risk stratification of patients with moderate-to-severe AR and no or minimal symptoms.

AB - Purpose: To determine the prognostic significance of cardiac MRI parameters in patients with moderate-to-severe aortic regurgitation (AR) and minimal or no symptoms through a network meta-analysis. Materials and Methods: This systematic review and network meta-analysis searched in PubMed, Embase, and Cochrane Library databases for articles published from January 1, 2000, to March 1, 2024, investigating the prognostic value of cardiac MRI parameters in patients with moderate-to-severe AR. The composite outcome included all-cause death, heart failure hospitalization, aortic valve replacement, new-onset heart failure symptoms, New York Heart Association class progression, and left ventricular ejection fraction less than 50%. Both pairwise and network meta-analyses were performed. Results: Eight studies with 1579 patients (1187 male patients [75%]; mean age, 55 years ± 5 [SD]) were included. Aortic regurgitant volume and regurgitant fraction were associated with a higher incidence of adverse events (pooled hazard ratio [HR], 1.04 per 1 mL increase [95% CI: 1.01, 1.06] and pooled HR, 1.09 per 1% increase [95% CI: 1.03, 1.16], respectively). Adverse remodeling, reflected by increased end-diastolic or end-systolic volume (pooled HR, 1.02 per 1 mL/m 2 [95% CI: 1.01, 1.03] and pooled HR, 1.02 per 1 mL/m 2 [95% CI: 1.01, 1.04], respectively), was predictive of worse outcome. Late gadolinium enhancement was associated with a twofold increased risk of developing the study end point (pooled HR, 1.86; 95% CI: 1.20, 2.89). T1 mapping and extracellular volume could not be assessed. Network meta-analysis disclosed that late gadolinium enhancement (P =.884) and regurgitant fraction (P =.727) were the most important prognostic factors. Conclusion: This network meta-analysis demonstrated the strong prognostic value of regurgitant fraction and left ventricular adverse remodeling as assessed with cardiac MRI in risk stratification of patients with moderate-to-severe AR and no or minimal symptoms.

KW - Humans

KW - Male

KW - Middle Aged

KW - Aortic Valve Insufficiency/diagnostic imaging

KW - Magnetic Resonance Imaging/methods

KW - Prognosis

KW - Severity of Illness Index

UR - https://www.scopus.com/pages/publications/105010864418

U2 - 10.1148/ryct.240313

DO - 10.1148/ryct.240313

M3 - Article

C2 - 40539915

SN - 2638-6135

VL - 7

JO - Radiology: Cardiothoracic Imaging

JF - Radiology: Cardiothoracic Imaging

IS - 3

M1 - e240313

ER -

Prognostic Value of Cardiovascular MRI in Asymptomatic Patients with Moderate-to-Severe Aortic Regurgitation: A Network Meta-Analysis

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this