Holodiastolic flow reversal

Last revised by Joachim Feger on 30 Apr 2023

Holodiastolic flow reversal (HDR) refers to a backward flow typically observed in the descending aorta during the whole diastolic phase and has been observed in the setting of moderate to severe aortic regurgitation.

It has been found to predict severe aortic regurgitation with high sensitivity and specificity (100 and 93% respectively) in the absence of congenital heart disease, for which it is also a presumably common finding 1,2.

It can be assessed noninvasively by velocity-encoded phase contrast imaging with cardiac MRI, it has been also assessed with transesophageal echocardiography 1-3.

Diastolic flow reversal is assessed on the proximal descending thoracic aorta using pulsed wave Doppler. The sample volume is placed in the vessel center at the level of the aortic isthmus distal to the origin of the left subclavian artery 1-2.

Diastolic flow reversal is typically assessed by a through-plane measurement perpendicular to the descending aorta at the level of the main pulmonary artery 1,4.

A holodiastolic retrograde flow with an end-diastolic flow velocity >20cm/s (measured at peak R wave) and a velocity time integral of >15cm is indicative of severe aortic regurgitation 1-2.

Significant holodiastolic flow reversal in the abdominal aorta is also a specific sign of severe aortic regurgitation 1.

A holodiastolic backward flow with a minimum of 10 mL/s was defined as a significant holodiastolic flow reversal by a study. This is also provided the flow is significantly larger than the respective flow measurement error 1.

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