A Novel Approach to Determine Aortic Valve Area with Phase-contrast cardiovascular Magnetic Resonance

Overview

Journal J Cardiovasc Magn Reson

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
Radiology

Date 2022 Jan 6

PMID 34986847

Citations 5

Authors

Felix Troger

Ivan Lechner

Martin Reindl

Christina Tiller

Magdalena Holzknecht

Mathias Pamminger

Christian Kremser

Johannes Schwaiger

Sebastian J Reinstadler

Axel Bauer

Bernhard Metzler

Agnes Mayr

Gert Klug

Affiliations

Soon will be listed here.

Abstract

Background: Transthoracic echocardiography (TTE) is the diagnostic routine standard for assessing aortic stenosis (AS). However, its inaccuracies in determining stroke volume (SV) and aortic valve area (AVA) call for a more precise and dependable method. Phase-contrast cardiovascular magnetic resonance imaging (PC-CMR) is a promising tool to push these boundaries. Thus, the aim of this study was to validate a novel approach based on PC-CMR against the gold-standard of invasive determination of AVA in AS compared to TTE.

Methods: A total of 50 patients with moderate or severe AS underwent TTE, cardiac catheterization and CMR. AVA via PC-CMR was determined by plotting momentary flow across the valve against flow-velocity. SV by CMR was measured directly via PC-CMR and volumetrically using cine-images. Invasive SV and AVA were determined via Fick-principle and Gorlin-formula, respectively. TTE yielded SV and AVA using continuity equation. Gradients were calculated via the modified Bernoulli-equation.

Results: SV by PC-CMR (85 ± 31 ml) correlated strongly (r: 0.73, p < 0.001) with cine-CMR (85 ± 19 ml) without significant bias (lower and upper limits of agreement (LLoA and ULoA): - 41 ml and 44 ml, p = 0.83). In PC-CMR, mean pressure gradient correlated significantly with invasive determination (r: 0.36, p = 0.011). Mean AVA, as determined by PC-CMR during systole (0.78 ± 0.25 cm), correlated moderately (r: 0.54, p < 0.001) with invasive AVA (0.70 ± 0.23 cm), resulting in a small bias of 0.08 cm (LLoA and ULoA: - 0.36 cm and 0.55 cm, p = 0.017). Inter-methodically, AVA by TTE (0.81 ± 0.23 cm) compared to invasive determination showed similar correlations (r: 0.58, p < 0.001 with a bias of 0.11 cm, LLoA and ULoA: - 0.30 and 0.52, p < 0.001) to PC-CMR. Intra- and interobserver reproducibility were excellent for AVA (intraclass-correlation-coefficients of 0.939 and 0.827, respectively).

Conclusions: Our novel approach using continuous determination of flow-volumes and velocities with PC-CMR enables simple AVA measurement with no bias to invasive assessment. This approach highlights non-invasive AS grading through CMR, especially when TTE findings are inconclusive.

Citing Articles

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References

Klug G, Reinstadler S, Feistritzer H, Kremser C, Schwaiger J, Reindl M . Cardiac index after acute ST-segment elevation myocardial infarction measured with phase-contrast cardiac magnetic resonance imaging. Eur Radiol. 2015; 26(7):1999-2008. DOI: 10.1007/s00330-015-4022-7. View

Bohbot Y, Renard C, Manrique A, Levy F, Marechaux S, Gerber B . Usefulness of Cardiac Magnetic Resonance Imaging in Aortic Stenosis. Circ Cardiovasc Imaging. 2020; 13(5):e010356. DOI: 10.1161/CIRCIMAGING.119.010356. View

Speiser U, Quick S, Haas D, Youssef A, Waessnig N, Ibrahim K . 3-T magnetic resonance for determination of aortic valve area: a comparison to echocardiography. Scand Cardiovasc J. 2014; 48(3):176-83. DOI: 10.3109/14017431.2014.906646. View

Abe H, Iguchi N, Utanohara Y, Takada K, Hen Y, Machida H . Planimetry of the Orifice Area in Aortic Valve Stenosis Using Phase-Contrast Cardiac Magnetic Resonance Imaging. Int Heart J. 2017; 59(1):77-80. DOI: 10.1536/ihj.16-542. View

Maganti K, Rigolin V, Sarano M, Bonow R . Valvular heart disease: diagnosis and management. Mayo Clin Proc. 2010; 85(5):483-500. PMC: 2861980. DOI: 10.4065/mcp.2009.0706. View

Hatle L, Angelsen B, Tromsdal A . Non-invasive assessment of aortic stenosis by Doppler ultrasound. Br Heart J. 1980; 43(3):284-92. PMC: 482277. DOI: 10.1136/hrt.43.3.284. View

Hakki A, Iskandrian A, Bemis C, KIMBIRIS D, Mintz G, SEGAL B . A simplified valve formula for the calculation of stenotic cardiac valve areas. Circulation. 1981; 63(5):1050-5. DOI: 10.1161/01.cir.63.5.1050. View

Garcia J, Capoulade R, Le Ven F, Gaillard E, Kadem L, Pibarot P . Discrepancies between cardiovascular magnetic resonance and Doppler echocardiography in the measurement of transvalvular gradient in aortic stenosis: the effect of flow vorticity. J Cardiovasc Magn Reson. 2013; 15:84. PMC: 3848817. DOI: 10.1186/1532-429X-15-84. View

Po J, Tong M, Meeran T, Potluri A, Raina A, Doyle M . Quantification of Cardiac Output with Phase Contrast Magnetic Resonance Imaging in Patients with Pulmonary Hypertension. J Clin Imaging Sci. 2020; 10:26. PMC: 7193209. DOI: 10.25259/JCIS_36_2020. View

10.

Nistri S, Faggiano P, Olivotto I, Papesso B, Bordonali T, Vescovo G . Hemodynamic progression and outcome of asymptomatic aortic stenosis in primary care. Am J Cardiol. 2011; 109(5):718-23. DOI: 10.1016/j.amjcard.2011.10.035. View

11.

Silveira J, Smyke M, Rich A, Liu Y, Jin N, Scandling D . Quantification of aortic stenosis diagnostic parameters: comparison of fast 3 direction and 1 direction phase contrast CMR and transthoracic echocardiography. J Cardiovasc Magn Reson. 2017; 19(1):35. PMC: 5339981. DOI: 10.1186/s12968-017-0339-5. View

12.

Wong S, Spina R, Toemoe S, Dhital K . Is cardiac magnetic resonance imaging as accurate as echocardiography in the assessment of aortic valve stenosis?. Interact Cardiovasc Thorac Surg. 2016; 22(4):480-6. DOI: 10.1093/icvts/ivv362. View

13.

Debl K, Djavidani B, Seitz J, Nitz W, Schmid F, Muders F . Planimetry of aortic valve area in aortic stenosis by magnetic resonance imaging. Invest Radiol. 2005; 40(10):631-6. DOI: 10.1097/01.rli.0000178362.67085.fd. View

14.

Alkhodair A, Tsang M, Cairns J, Swiston J, Levy R, Lee L . Comparison of thermodilution and indirect Fick cardiac outputs in pulmonary hypertension. Int J Cardiol. 2018; 258:228-231. DOI: 10.1016/j.ijcard.2018.01.076. View

15.

Du Bois D, Du Bois E . A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition. 1989; 5(5):303-11; discussion 312-3. View

16.

Baumgartner H, Falk V, Bax J, De Bonis M, Hamm C, Holm P . 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38(36):2739-2791. DOI: 10.1093/eurheartj/ehx391. View

17.

Sirin S, Nassenstein K, Neudorf U, Jensen C, Mikat C, Schlosser T . Quantification of congenital aortic valve stenosis in pediatric patients: comparison between cardiac magnetic resonance imaging and transthoracic echocardiography. Pediatr Cardiol. 2013; 35(5):771-7. DOI: 10.1007/s00246-013-0851-9. View

18.

Puymirat E, Chassaing S, Trinquart L, Barbey C, Chaudeurge A, Bar O . Hakki's formula for measurement of aortic valve area by magnetic resonance imaging. Am J Cardiol. 2010; 106(2):249-54. DOI: 10.1016/j.amjcard.2010.03.019. View

19.

Chin C, Khaw H, Luo E, Tan S, White A, Newby D . Echocardiography underestimates stroke volume and aortic valve area: implications for patients with small-area low-gradient aortic stenosis. Can J Cardiol. 2014; 30(9):1064-72. PMC: 4161727. DOI: 10.1016/j.cjca.2014.04.021. View

20.

Caruthers S, Lin S, Brown P, Watkins M, Williams T, Lehr K . Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography. Circulation. 2003; 108(18):2236-43. DOI: 10.1161/01.CIR.0000095268.47282.A1. View