{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:11:32Z","timestamp":1792145492293,"version":"4.4.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"the Elkins Family Distinguished Chair Fund"},{"name":"Cardiovascular Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess whether two-dimensional measurements of flow convergence (FC) from the standard parasternal long-axis (PLA) window relate to aortic regurgitation (AR) severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients with chronic AR who underwent transthoracic echocardiography and cardiac magnetic resonance imaging (CMR) within 4\u2005h were included. FCPLA was assessed using 3 parameters: the maximum length (Lmax), width (Dmax), and hemispheric area. Traditional echo\/Doppler parameters of AR severity were measured per guidelines. FC and other echo\/Doppler results were compared to CMR-derived regurgitant volume (RegV). A total of 80 patients were evaluated. AR was significant by CMR (RegV &amp;gt; 45\u2005mL) in 41% of patients. FCPLA parameters were measurable in 83% of patients whereas apical PISA quantitation was feasible in only 39%. FCPLA measurements correlated well with CMR RegV: Spearman \u03c1 = 0.75 for Lmax, \u03c1 = 0.65 for Dmax, and \u03c1 = 0.78 for area. The AUC values of Lmax = 0.55\u2005cm, Dmax = 0.65\u2005cm, and FCPLA area = 0.35\u2005cm2 for identifying significant AR were 0.98, 0.84, and 0.94, respectively, with Lmax and FC area demonstrating significantly higher AUCs. They were comparable to those of vena contracta width (AUC = 0.94) and left ventricular end-diastolic volume index (AUC = 0.91) and superior to those of jet width\/LVOT diameter (AUC = 0.80), descending aorta end-diastolic velocity (AUC = 0.74), and pressure half-time (AUC = 0.71).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In chronic AR, flow convergence is more identifiable from the parasternal long axis window compared to traditional PISA measured from the apical window. FCPLA nonvolumetric parameters relate well to AR severity by CMR and are comparable to conventional echo\/Doppler parameters.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf359","type":"journal-article","created":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T12:45:06Z","timestamp":1766321106000},"page":"831-839","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of aortic regurgitation severity using flow convergence from the parasternal window: comparison with cardiac magnetic resonance and traditional Doppler parameters"],"prefix":"10.1093","volume":"27","author":[{"given":"Jad","family":"Zeitoun","sequence":"first","affiliation":[{"name":"Chair, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center , 6550 Fannin St, Smith Tower - Suite 1801, Houston, TX 77030 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowa","family":"Attar","sequence":"additional","affiliation":[{"name":"Chair, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center , 6550 Fannin St, Smith Tower - Suite 1801, Houston, TX 77030 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maan","family":"Malahfji","sequence":"additional","affiliation":[{"name":"Chair, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center , 6550 Fannin St, Smith Tower - Suite 1801, Houston, TX 77030 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Angulo","sequence":"additional","affiliation":[{"name":"Chair, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center , 6550 Fannin St, Smith Tower - Suite 1801, Houston, TX 77030 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipan J","family":"Shah","sequence":"additional","affiliation":[{"name":"Chair, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center , 6550 Fannin St, Smith Tower - Suite 1801, Houston, TX 77030 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3441-440X","authenticated-orcid":false,"given":"William A","family":"Zoghbi","sequence":"additional","affiliation":[{"name":"Chair, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center , 6550 Fannin St, Smith Tower - Suite 1801, Houston, TX 77030 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"2026032620571492300_jeaf359-B1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2026032620571492300_jeaf359-B2","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1093\/ehjci\/jeab253","article-title":"Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper","volume":"23","author":"Lancellotti","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026032620571492300_jeaf359-B3","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/S0735-1097(98)00356-8","article-title":"Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation","volume":"32","author":"Tribouilloy","year":"1998","journal-title":"J Am Coll Cardiol"},{"key":"2026032620571492300_jeaf359-B4","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.amjcard.2008.04.011","article-title":"Accuracy of the flow convergence method for quantification of aortic regurgitation in patients with central versus eccentric jets","volume":"102","author":"Pouleur","year":"2008","journal-title":"Am J Cardiol"},{"key":"2026032620571492300_jeaf359-B5","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/S0002-9149(99)00016-8","article-title":"New echocardiographic windows for quantitative determination of aortic regurgitation volume using color Doppler flow convergence and vena contracta","volume":"83","author":"Shiota","year":"1999","journal-title":"Am J Cardiol"},{"key":"2026032620571492300_jeaf359-B6","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0894-7317(97)70089-0","article-title":"Usefulness of color Doppler proximal isovelocity surface area method in quantitating valvular regurgitation","volume":"10","author":"Yamachika","year":"1997","journal-title":"J Am Soc Echocardiogr"},{"key":"2026032620571492300_jeaf359-B7","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jcmg.2024.08.013","article-title":"Echocardiographic evaluation of chronic aortic regurgitation: comparison with cardiac magnetic resonance and implications for guideline recommendations","volume":"18","author":"Attar","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026032620571492300_jeaf359-B8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"2026032620571492300_jeaf359-B9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12947-015-0016-5","article-title":"Severity of aortic regurgitation assessed by area of vena contracta: a clinical two-dimensional and three-dimensional color Doppler imaging study","volume":"13","author":"Sato","year":"2015","journal-title":"Cardiovasc Ultrasound"},{"key":"2026032620571492300_jeaf359-B10","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1161\/01.CIR.102.5.558","article-title":"Assessment of severity of aortic regurgitation using the width of the vena contracta: a clinical color Doppler imaging study","volume":"102","author":"Tribouilloy","year":"2000","journal-title":"Circulation"},{"key":"2026032620571492300_jeaf359-B11","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/j.echo.2011.08.009","article-title":"Comparison of semiquantitative and quantitative assessment of severity of aortic regurgitation: clinical implications","volume":"24","author":"Messika-Zeitoun","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"key":"2026032620571492300_jeaf359-B12","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1007\/s10554-015-0707-x","article-title":"Automatic quantification of aortic regurgitation using 3D full volume color Doppler echocardiography: a validation study with cardiac magnetic resonance imaging","volume":"31","author":"Choi","year":"2015","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026032620571492300_jeaf359-B13","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1111\/j.1540-8175.2005.00171.x","article-title":"Assessment of aortic regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area: usefulness and validation","volume":"22","author":"Fang","year":"2005","journal-title":"Echocardiography"},{"key":"2026032620571492300_jeaf359-B14","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/j.1540-8175.2009.00988.x","article-title":"The correlation between three-dimensional vena contracta area and aortic regurgitation index in patients with aortic regurgitation","volume":"27","author":"Chin","year":"2010","journal-title":"Echocardiography"},{"key":"2026032620571492300_jeaf359-B15","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.ijcard.2011.11.094","article-title":"3D color-Doppler echocardiography and chronic aortic regurgitation: a novel approach for severity assessment","volume":"166","author":"Perez de Isla","year":"2013","journal-title":"Int J Cardiol"},{"key":"2026032620571492300_jeaf359-B16","doi-asserted-by":"crossref","first-page":"e014901","DOI":"10.1161\/CIRCIMAGING.122.014901","article-title":"Multiparametric strategy to predict early disease decompensation in asymptomatic severe aortic regurgitation","volume":"15","author":"Ko\u010dkov\u00e1","year":"2022","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026032620571492300_jeaf359-B17","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/S0735-1097(87)80254-1","article-title":"Evaluation of aortic insufficiency by Doppler color flow mapping","volume":"9","author":"Perry","year":"1987","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/advance-article-pdf\/doi\/10.1093\/ehjci\/jeaf359\/66109676\/jeaf359.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/4\/831\/66109676\/jeaf359.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/4\/831\/66109676\/jeaf359.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:57:23Z","timestamp":1774573043000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/27\/4\/831\/8402171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,22]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12,22]]},"published-print":{"date-parts":[[2026,3,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeaf359","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2025,12,22]]}}}