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Grading of aortic stenosis severity: a head-to-head comparison between cardiac magnetic resonance imaging and echocardiography

  • CARDIAC RADIOLOGY
  • Published:
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Abstract

Aim

To prospectively evaluate the accuracy of cardiac magnetic resonance (cMR) imaging for the assessment of aortic valve effective orifice area (EOA) by continuity equation and anatomical aortic valve area (AVA) by direct planimetry, as compared with transthoracic (TTE) and transesophageal (TEE) two-dimensional (2D) echocardiography, respectively.

Methods and results

A total of 31 patients (21 men, 10 women, mean age 69 ± 10 years) with moderate-to-severe aortic stenosis (AS) diagnosed by TTE and scheduled for elective aortic valve replacement, underwent both cMR and TEE. AVA by cMR was obtained from balanced steady-state free-precession cine-images. EOA was computed from phase-contrast MR flow analysis. AVA at cMR (0.93 ± 0.42 cm2) was highly correlated with TEE-derived planimetry (0.92 ± 0.32 cm2) (concordance correlation coefficient, CCC = 0.85). By excluding 11 patients with extensively thickened and heavily calcified cusps, the CCC increased to 0.93. EOA at cMR (0.86 ± 0.30 cm2) showed a strong correlation with TTE-derived EOA (0.78 ± 0.25 cm2) (CCC = 0.82).

Conclusions

cMR imaging is an accurate alternative for the grading of AS severity. Its use may be recommended especially in patients with poor transthoracic acoustic windows and/or in case of discordance between 2D echocardiographic parameters.

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Abbreviations

AVA:

Aortic valve area

AS:

Aortic valve stenosis

EOA:

Effective orifice area

CMR:

Cardiac magnetic resonance

TTE:

Transthoracic echocardiography

TEE:

Transesophageal echocardiography

CT:

Computed tomography

bSSFP:

Balanced steady-state free precession

PC:

Phase-contrast

VENC:

Encoding velocity

CCC:

Concordance correlation coefficient

LVEF:

Left ventricular ejection fraction

LVOT:

Left ventricular outflow tract

LVOTCSA :

Left ventricular outflow tract cross-sectional area

VTI:

Velocity time integral

V:

Peak jet velocity

VAO:

Peak aortic jet velocity

VLVOT:

Peak left ventricular outflow tract jet velocity

SV:

Stroke volume

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Acknowledgements

No funding sources to be acknowledged from the Italian team. The part of this work performed in the UK was partially supported by the NIHR Bristol Cardiovascular Biomedical Research Unit (to Dr Chiara Bucciarelli-Ducci). The content of this work represents the opinion of the authors and not of the UK Department of Health.

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Authors and Affiliations

  1. Section of Diagnostic Imaging and Therapy-Radiology Division, Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy

    Cesare Mantini, Antonio Raffaele Cotroneo & Armando Tartaro

  2. Section and Cardiovascular Surgery Division, “G. d’Annunzio” University, Chieti, Italy

    Gabriele Di Giammarco

  3. Section of Cardiovascular Sciences and Cardiology Division, University Cardiology Division, “G. d’Annunzio” University – Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 31, 66013, Chieti, Italy

    Jacopo Pizzicannella, Sabina Gallina, Fabrizio Ricci, Emilia D’Ugo, Marziale Marchetti & Raffaele De Caterina

  4. NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK

    Nauman Ahmed & Chiara Bucciarelli-Ducci

  5. University of Bristol, Bristol, UK

    Nauman Ahmed & Chiara Bucciarelli-Ducci

  6. National Heart and Lung Institute, Imperial College London, London, UK

    Chiara Bucciarelli-Ducci

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  1. Cesare Mantini
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  2. Gabriele Di Giammarco
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  10. Chiara Bucciarelli-Ducci
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  12. Raffaele De Caterina
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Corresponding author

Correspondence to Raffaele De Caterina.

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No conflicts of interest as to the content of this manuscript are reported by any of the authors.

Ethical approval

All procedures performed in studies here presented and involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Not applicable: retrospective analysis of data acquired for clinical purpose: as such, approval from the local Ethics Committee was not necessary and was not sought.

Informed consent

Informed consent for the performance of the diagnostic examinations here reported was obtained from all individual participants included in the study.

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Mantini, C., Di Giammarco, G., Pizzicannella, J. et al. Grading of aortic stenosis severity: a head-to-head comparison between cardiac magnetic resonance imaging and echocardiography. Radiol med 123, 643–654 (2018). https://doi.org/10.1007/s11547-018-0895-2

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  • DOI: https://doi.org/10.1007/s11547-018-0895-2

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