Aortic Valve Area and Strain Measurements by Cardiac MRI and Transthoracic Echocardiography in Severe Aortic Stenosis with Normal Left Ventricular Function

Overview

Journal Iran J Med Sci

Publisher Shiraz University of Medical Sciences

Specialty General Medicine

Date 2023 Jul 17

PMID 37456208

Authors

Nahid Rezaeian

Leila Hosseini

Niloufar Samiei

Maryam Azimian

Alireza Rashidinejad

Yaser Toloueitabar

Mohammad Mehdi Hemmati Komasi

Leila Shayan

Sanaz Asadian

Affiliations

Soon will be listed here.

Abstract

Background: Transthoracic echocardiography (TTE) is the recommended imaging technique for the evaluation of patients with aortic stenosis (AS). However, in cases with inconclusive findings, cardiac magnetic resonance (CMR) planimetry is used to grade AS severity. This study aimed to compare the results derived from TTE and CMR in patients with severe AS with normal left ventricular (LV) function.

Methods: In a prospective study, 20 patients with severe AS were recruited and data derived from TTE and CMR modalities were compared with the archived records of 28 age- and sex-matched healthy controls. The data included aortic valve area (AVA), MRI-derived biventricular global strains, and TTE-derived global longitudinal strain (GLS). SPSS software was used to analyze the data with independent samples test, intraclass correlation coefficient (ICC), and Pearson correlation. P<0.05 was considered statistically significant.

Results: An excellent agreement was found in AVA values derived from CMR and TTE with an average ICC of 0.932 (95% CI=0.829-0.973). There was a significant difference in LV-GLS, LV global radial strain (GRS), right ventricular (RV) GRS, and RV global circumferential strain between the groups. A good correlation was found between CMR- and TTE-derived GLS with an average ICC of 0.721 (95% C=0.255-0.896). The mean aortic valve pressure gradient in TTE had a significant inverse linear correlation with LV-GRS in CMR (r=-0.537). All P values were <0.05.

Conclusion: There was a good agreement between AVA and strain values derived from cardiac MRI and TTE. The myocardial strain was impaired in patients with severe AS and normal LV function and correlated with disease severity.

Citing Articles

Computational Model for Early-Stage Aortic Valve Calcification Shows Hemodynamic Biomarkers.

Mirza A, Hsu C, Rodriguez A, Alvarez P, Lou L, Sey M Bioengineering (Basel). 2024; 11(10).

PMID: 39451331 PMC: 11504039. DOI: 10.3390/bioengineering11100955.

References

Kusunose K, Goodman A, Parikh R, Barr T, Agarwal S, Popovic Z . Incremental prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis and preserved ejection fraction. Circ Cardiovasc Imaging. 2014; 7(6):938-45. DOI: 10.1161/CIRCIMAGING.114.002041. View

Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G . Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007; 28(2):230-68. DOI: 10.1093/eurheartj/ehl428. View

Kearney L, Lu K, Ord M, Patel S, Profitis K, Matalanis G . Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2012; 13(10):827-33. DOI: 10.1093/ehjci/jes115. View

Hwang J, Kim S, Park S, Cho E, Kim E, Chang S . Assessment of reverse remodeling predicted by myocardial deformation on tissue tracking in patients with severe aortic stenosis: a cardiovascular magnetic resonance imaging study. J Cardiovasc Magn Reson. 2017; 19(1):80. PMC: 5654100. DOI: 10.1186/s12968-017-0392-0. View

Jafari F, Maddah Safaei A, Hosseini L, Asadian S, Kamangar T, Zadehbagheri F . The role of cardiac magnetic resonance imaging in the detection and monitoring of cardiotoxicity in patients with breast cancer after treatment: a comprehensive review. Heart Fail Rev. 2020; 26(3):679-697. DOI: 10.1007/s10741-020-10028-y. View

Chimura M, Onishi T, Tsukishiro Y, Sawada T, Kiuchi K, Shimane A . Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy. Heart. 2016; 103(9):679-686. DOI: 10.1136/heartjnl-2016-309746. View

Voigt J, Pedrizzetti G, Lysyansky P, Marwick T, Houle H, Baumann R . Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2014; 16(1):1-11. DOI: 10.1093/ehjci/jeu184. View

Otto C, Kuusisto J, REICHENBACH D, Gown A, OBrien K . Characterization of the early lesion of 'degenerative' valvular aortic stenosis. Histological and immunohistochemical studies. Circulation. 1994; 90(2):844-53. DOI: 10.1161/01.cir.90.2.844. View

Miyazaki S, Daimon M, Miyazaki T, Onishi Y, Koiso Y, Nishizaki Y . Global longitudinal strain in relation to the severity of aortic stenosis: a two-dimensional speckle-tracking study. Echocardiography. 2011; 28(7):703-8. DOI: 10.1111/j.1540-8175.2011.01419.x. View

10.

Marciniak A, Glover K, Sharma R . Cohort profile: prevalence of valvular heart disease in community patients with suspected heart failure in UK. BMJ Open. 2017; 7(1):e012240. PMC: 5278264. DOI: 10.1136/bmjopen-2016-012240. View

11.

Lindroos M, Kupari M, Heikkila J, Tilvis R . Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol. 1993; 21(5):1220-5. DOI: 10.1016/0735-1097(93)90249-z. View

12.

Mihaljevic T, Nowicki E, Rajeswaran J, Blackstone E, Lagazzi L, Thomas J . Survival after valve replacement for aortic stenosis: implications for decision making. J Thorac Cardiovasc Surg. 2008; 135(6):1270-8. DOI: 10.1016/j.jtcvs.2007.12.042. View

13.

Ng A, Delgado V, Bertini M, Antoni M, van Bommel R, van Rijnsoever E . Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: a two-dimensional speckle tracking analysis. Eur Heart J. 2011; 32(12):1542-50. DOI: 10.1093/eurheartj/ehr084. View

14.

Yoon Y, Hong Y, Kim H, Kim J, Na J, Yang D . 2014 Korean guidelines for appropriate utilization of cardiovascular magnetic resonance imaging: a joint report of the Korean Society of Cardiology and the Korean Society of Radiology. Korean J Radiol. 2014; 15(6):659-88. PMC: 4248622. DOI: 10.3348/kjr.2014.15.6.659. View

15.

Pai R, Varadarajan P, Razzouk A . Survival benefit of aortic valve replacement in patients with severe aortic stenosis with low ejection fraction and low gradient with normal ejection fraction. Ann Thorac Surg. 2008; 86(6):1781-9. DOI: 10.1016/j.athoracsur.2008.08.008. View

16.

Dahl J, Videbaek L, Poulsen M, Rudbaek T, Pellikka P, Moller J . Global strain in severe aortic valve stenosis: relation to clinical outcome after aortic valve replacement. Circ Cardiovasc Imaging. 2012; 5(5):613-20. DOI: 10.1161/CIRCIMAGING.112.973834. View

17.

Stokke T, Hasselberg N, Smedsrud M, Sarvari S, Haugaa K, Smiseth O . Geometry as a Confounder When Assessing Ventricular Systolic Function: Comparison Between Ejection Fraction and Strain. J Am Coll Cardiol. 2017; 70(8):942-954. DOI: 10.1016/j.jacc.2017.06.046. View

18.

Asadian S, Rezaeian N, Hosseini L, Toloueitabar Y, Hemmati Komasi M, Shayan L . How does iron deposition modify the myocardium? A feature-tracking cardiac magnetic resonance study. Int J Cardiovasc Imaging. 2021; 37(11):3269-3277. DOI: 10.1007/s10554-021-02305-0. View

19.

Mor-Avi V, Lang R, Badano L, Belohlavek M, Cardim N, Derumeaux G . Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011; 24(3):277-313. DOI: 10.1016/j.echo.2011.01.015. View

20.

Onishi T, Saha S, Delgado-Montero A, Ludwig D, Onishi T, Schelbert E . Global longitudinal strain and global circumferential strain by speckle-tracking echocardiography and feature-tracking cardiac magnetic resonance imaging: comparison with left ventricular ejection fraction. J Am Soc Echocardiogr. 2015; 28(5):587-96. DOI: 10.1016/j.echo.2014.11.018. View