Relationship between the left-to-right ventricular volume ratio and aortic regurgitation severity: an echocardiographic and cardiac magnetic resonance imaging study

Altes, Alexandre;Hanet, Vincent;Cardot, Bérengère;Vancraeynest, David;Maréchaux, Sylvestre;et.al.
(2026) EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING — Vol. 27, n° 2, p. 118-128 (2025)

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Authors
  • Altes, Alexandreorcid-logoGCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, DataCoeur, Lille Catholic University , Rue du Grand But, Lille 59130 ,
    Author
  • Hanet, VincentUCLouvain
    Author
  • Cardot, BérengèreGCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, DataCoeur, Lille Catholic University , Rue du Grand But, Lille 59130 ,
    Author
  • Vancraeynest, DavidUCLouvain
    Author
  • Pasquet, AgnesUCLouvain
    Author
  • Gerber, Bernhardorcid-logoUCLouvain
    Author
  • Maréchaux, SylvestreGCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, DataCoeur, Lille Catholic University , Rue du Grand But, Lille 59130 ,
    Author
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Abstract
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>Left ventricular (LV) enlargement in chronic aortic regurgitation (AR) is commonly assessed using diameters and volumes. However, these measures are influenced by body size, sex, and age. The left-to-right ventricular end-diastolic volume ratio (LV/RV ratio), assessed by cardiac magnetic resonance imaging (CMR) and known to remain close to 1 in healthy individuals, could provide a more individualized marker of LV remodeling in chronic AR.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results</jats:title> <jats:p>This bi-centre study included 258 patients with chronic AR (median age: 55 years, 18% women) who underwent echocardiography (Echo) and CMR. LV and RV volumes were measured from cine-CMR images. Associations between the LV/RV ratio, conventional LV measures, and significant AR, defined as Grades 3–4 on Echo or aortic regurgitant fraction (AR-RegFrac) ≥ 33% on CMR, were analysed using area under the curve (AUC) and logistic regression. The median LV/RV ratio was 1.5 [1.3–1.9], increased with AR severity (P &amp;lt; 0.001), and correlated more strongly with AR-RegFrac (r = 0.67; P &amp;lt; 0.001) than conventional LV measures. The LV/RV ratio identified significant AR with good accuracy (Echo, AUC 0.77; CMR, AUC 0.83). A threshold of 1.5 provided balanced sensitivity and specificity (Se 71–84%, Sp 77–75%), while 1.8 ruled in significant AR with high specificity (Sp 91% for both modalities). The LV/RV ratio did not vary significantly by age or sex and showed consistent performance across subgroups.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The LV/RV ratio is a reliable and individualized marker of LV remodeling in chronic AR. These findings support its potential role in clinical assessment and further evaluation in outcome studies.</jats:p> </jats:sec>
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Altes, A., Hanet, V., Cardot, B., Vancraeynest, D., Pasquet, A., Delelis, F., Lebouazda, A., Tartare, F., Tristram, D., Toledano, M., Silvestri, V., Gerber, B., & Maréchaux, S. (2026). Relationship between the left-to-right ventricular volume ratio and aortic regurgitation severity: an echocardiographic and cardiac magnetic resonance imaging study. EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, 27(2), 118-128. https://doi.org/10.1093/EHJCI/JEAF251 (Original work published 2025)