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This study investigated (1) the variability of the ascending aortic flow waveform in children and adolescents with\/without a childhood heart disease history (CHD); (2) the accuracy of WSA obtained with a representative flow waveform (RepFlow), compared with the triangulation method and published ultrasound-derived adult representative flow; (3) the impact of limitations in Doppler ultrasound on WSA; and (4) generalizability of results to adults with a history of CHD. Phase contrast MRI was performed in youth without (<jats:italic>n<\/jats:italic>\u2009=\u200945, Group 1, 10\u201319\u00a0years) and with CHD (<jats:italic>n<\/jats:italic>\u2009=\u200979, Group 2, 7\u201318\u00a0years), and adults with CHD history (<jats:italic>n<\/jats:italic>\u2009=\u200929, Group 3, 19\u201359\u00a0years). Segmented aortic cross-sectional area was used as a surrogate for the central pressure waveform in WSA. A subject-specific virtual Doppler ultrasound was performed on MRI data by extracting velocities from a sample volume. Time\/amplitude-normalized ascending aortic flow waveforms were highly consistent amongst all groups. WSA with RepFlow therefore yielded errors\u2009&lt;\u200910% in all groups for reflected wave magnitude and return time. Absolute errors were typically 1.5\u20133 times greater with other methods, including subject-specific (best-case\/virtual) Doppler ultrasound, for which velocity profile skewing introduced waveform errors. Our data suggest that RepFlow is the optimal approach for pressure-only WSA in children and adolescents with\/without CHD, as well as adults with CHD history, and may even be more accurate than subject-specific Doppler ultrasound in the ascending aorta.<\/jats:p>","DOI":"10.1007\/s10439-023-03339-2","type":"journal-article","created":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T14:03:38Z","timestamp":1691676218000},"page":"2772-2784","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Superiority of a Representative MRI Flow Waveform over Doppler Ultrasound for Aortic Wave Reflection Assessment in Children and Adolescents With\/Without a History of Heart Disease"],"prefix":"10.1007","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5692-2106","authenticated-orcid":false,"given":"Jonathan P.","family":"Mynard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remi","family":"Kowalski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary A.","family":"Harrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avinash","family":"Kondiboyina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph J.","family":"Smolich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M. 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