Abstract
We compared two different magnetic resonance (MR) sequences [steady-state free precession (SSFP) and gradient echo fast low-angle shot (FLASH)] for the assessment of aortic valve areas in aortic stenosis using transesophageal echocardiography (TEE) as the standard of reference. Thirty-two patients with known aortic stenosis underwent MR (1.5 T) using a cine SSFP sequence and a cine FLASH sequence. Planimetry was performed in cross-sectional images and compared to the results of the TEE. In seven patients the grade of stenosis was additionally assessed by invasive cardiac catheterization (ICC). The mean aortic valve area measured by TEE was 0.97±0.19 mm2, 1.00±0.25 mm2 for SSFP and 1.25±0.23 mm2 based on FLASH images. The mean difference between the valve areas assessed based on SSFP and TEE images was 0.15±0.13 cm2 (FLASH vs TEE: 0.29±0.17 cm2). Bland-Altman analysis demonstrated that measurements using FLASH images overestimated the aortic valve area compared to TEE. Comparing ICC with MRI and TEE, only a weak to moderate correlation was found (ICC vs TEE: R=0.52, p=0.22; ICC vs SSFP: R=0.20, p=0.65; ICC vs FLASH: R=0.16, p=0.70). Measurements of the aortic valve area based on SSFP images correlate better with TEE compared to FLASH images.
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References
(1995) Vital and health statistics. National Center for Health Statistics, Hyattsville, MD, p 127
Selzer A (1987) Changing aspects of the natural history of valvular aortic stenosis. N Engl J Med 317:91–98
Smith N, McAnulty JH, Rahimtoola SH (1978) Severe aortic stenosis with impaired left ventricular function and clinical heart failure: results of valve replacement. Circulation 58:255–264
Bonow RO, Carabello B, de Leon AC et al (1998) ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Heart Valve Dis 7:672–707
Otto CM, Pearlman AS, Comess KA, Reamer RP, Janko CL, Huntsman LL (1986) Determination of the stenotic aortic valve area in adults using Doppler echocardiography. J Am Coll Cardiol 7:509–517
Skjaerpe T, Hegrenaes L, Hatle L (1985) Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation 72:810–818
Tardif JC, Miller DS, Pandian NG et al (1995) Effects of variations in flow on aortic valve area in aortic stenosis based on in vivo planimetry of aortic valve area by multiplane transesophageal echocardiography. Am J Cardiol 76:193–198
Tardif JC, Rodrigues AG, Hardy JF et al (1997) Simultaneous determination of aortic valve area by the Gorlin formula and by transesophageal echocardiography under different transvalvular flow conditions. Evidence that anatomic aortic valve area does not change with variations in flow in aortic stenosis. J Am Coll Cardiol 29:1296–1302
John AS, Dill T, Brandt RR et al (2003) Magnetic resonance to assess the aortic valve area in aortic stenosis: how does it compare to current diagnostic standards? J Am Coll Cardiol 42:519–526
Caruthers SD, Lin SJ, Brown P et al (2003) Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography. Circulation 108:2236–2243
Gorlin R, Gorlin SG (1951) Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J 41:1–29
Rahimtoola SH (1989) Perspective on valvular heart disease: an update. J Am Coll Cardiol 14:1–23
Friedrich M, Schulz-Menger J, Dietz R (2004) Magnetic resonance to assess the aortic valve area in aortic stenosis. J Am Coll Cardiol 43:2148; 2148–2149 author reply
Hildebrand LB, Buonocore MH (2002) Fully refocused gradient recalled echo (FRGRE): factors affecting flow and motion sensitivity in cardiac MRI. J Cardiovasc Magn Reson 4:211–222
Friedrich MG, Schulz-Menger J, Poetsch T, Pilz B, Uhlich F, Dietz R (2002) Quantification of valvular aortic stenosis by magnetic resonance imaging. Am Heart J 144:329–334
Barkhausen J, Ruehm SG, Goyen M, Buck T, Laub G, Debatin JF (2001) MR evaluation of ventricular function: true fast imaging with steady-state precession versus fast low-angle shot cine MR imaging: feasibility study. Radiology 219:264–269
Moon JC, Lorenz CH, Francis JM, Smith GC, Pennell DJ (2002) Breath-hold FLASH and FISP cardiovascular MR imaging: left ventricular volume differences and reproducibility. Radiology 223:789–797
Kunz RP, Oellig F, Krummenauer F et al (2005) Assessment of left ventricular function by breath-hold cine MR imaging: comparison of different steady-state free precession sequences. J Magn Reson Imaging 21:140–148
Omran H, Schmidt H, Hackenbroch M et al (2003) Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet 361:1241–1246
Baumgartner H, Stefenelli T, Niederberger J, Schima H, Maurer G (1999) “Overestimation” of catheter gradients by Doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery. J Am Coll Cardiol 33:1655–1661
Garcia D, Dumesnil JG, Durand LG, Kadem L, Pibarot P (2003) Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity. J Am Coll Cardiol 41:435–442
Gilkeson RC, Markowitz AH, Balgude A, Sachs PB (2006) MDCT evaluation of aortic valvular disease. AJR Am J Roentgenol 186:350–360
Hunold P, Vogt FM, Schmermund A et al (2003) Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT. Radiology 226:145–152
Miller S, Simonetti OP, Carr J, Kramer U, Finn JP (2002) MR Imaging of the heart with cine true fast imaging with steady-state precession: influence of spatial and temporal resolutions on left ventricular functional parameters. Radiology 223:263–269
Waltering KU, Hunold P, Bruder O, Schlosser T, Jochims M, Barkhausen J (2004) Steady-state free precession CINE MR: influence of different reconstruction algorithms on image quality. J Cardiovasc Magn Reson 6:407
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Schlosser, T., Malyar, N., Jochims, M. et al. Quantification of aortic valve stenosis in MRI—comparison of steady-state free precession and fast low-angle shot sequences. Eur Radiol 17, 1284–1290 (2007). https://doi.org/10.1007/s00330-006-0437-5
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DOI: https://doi.org/10.1007/s00330-006-0437-5