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Troger F, Kremser C, Pamminger M, Reinstadler SJ, Thurner GC, Henninger B, Klug G, Metzler B, Mayr A. Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis. IJC HEART & VASCULATURE 2024; 51:101357. [PMID: 38356930 PMCID: PMC10863308 DOI: 10.1016/j.ijcha.2024.101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Background Aortic stenosis (AS) is one of the most prevalent valvular heart-diseases in Europe. Currently, diagnosis and classification are not sex-sensitive; however, due to a distinctly different natural history of AS, further investigations of sex-differences in AS-patients are needed. Thus, this study aimed to detect sex-differences in severe AS, especially concerning flow-patterns, via phase-contrast cardiac magnetic resonance imaging (PC-CMR). Methods Forty-four severe AS-patients (20 women, 45 % vs. 24 men, 55 %) with a median age of 72 years underwent transthoracic echocardiography (TTE), cardiac catheterization (CC) and CMR. Aortic valve area (AVA) and stroke volume (SV) were determined in all modalities, with CMR yielding geometrical AVA via cine-planimetry and functional AVA via PC-CMR, the latter being also used to examine flow-properties. Results Geometrical AVA showed no sex-differences (0.91 cm2, IQR: 0.61-1.14 vs. 0.94 cm2, IQR: 0.77-1.22, p = 0.322). However, functional AVA differed significantly between sexes in all three modalities (TTE: p = 0.044; CC/PC-CMR: p < 0.001). In men, no significant intermethodical biases in functional AVA-measurements between modalities were found (p = 0.278); yet, in women the particular measurements differed significantly (p < 0.001). Momentary flowrate showed sex-differences depending on momentary opening-degree (at 50 %, 75 % and 90 % of peak-AVA, all p < 0.001), with men showing higher flowrates with increasing opening-area. In women, flowrate did not differ between 75 % and 90 % of peak-AVA (p = 0.191). Conclusions In severe AS-patients, functional AVA showed marked sex-differences in all modalities, whilst geometrical AVA did not differ. Inter-methodical biases were negligible in men, but not in women. Lastly, significant sex-differences in flow-patterns fit in with the different pathogenesis of AS.
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Affiliation(s)
- Felix Troger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Christian Kremser
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Gudrun C Thurner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44 6020, Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Gert Klug
- Department of Internal Medicine, County Hospital Bruck an der Mur, Tragoesser Strasse 1 8600, Bruck an der Mur, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
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Alaour B, Nakase M, Pilgrim T. Combined Significant Aortic Stenosis and Mitral Regurgitation: Challenges in Timing and Type of Intervention. Can J Cardiol 2024; 40:235-249. [PMID: 37931671 DOI: 10.1016/j.cjca.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
In this narrative review, we aim to summarize the literature surrounding the assessment and management of the common, yet understudied combination of aortic stenosis (AS) and mitral regurgitation (MR), the components of which are complexly inter-related and interdependent from diagnostic, prognostic, and therapeutic perspectives. The hemodynamic interdependency of AS and MR confounds the assessment of the severity of each valve disease, thus underscoring the importance of a multimodal approach integrating valvular and extravalvular indicators of severity. A large body of literature suggests that baseline MR is associated with reduced survival post aortic valve (AV) intervention and that regression of MR post-AV intervention confers a mortality benefit. Functional MR is more likely to regress after AV intervention than primary MR. The respective natural courses of the 2 valve diseases are not synchronized; therefore, significant AS and MR at or above the respective threshold for intervention might not coincide. Surgery is primarily a 1-stop-shop procedure because of a considerable perioperative risk of repeat interventions, whereas transcatheter treatment modalities allow for a more tailored timing of intervention with reassessment of concomitant MR after AV replacement and a potential staged intervention in the absence of MR regression. In summary, AS and MR, when combined, are interlaced into a complex hemodynamic, diagnostic, and prognostic synergy, with important therapeutic implications. Contemporary approaches should consider stepwise intervention by exploiting the advantage of transcatheter options. However, evidence is needed to demonstrate the efficacy of different timing and therapeutic options.
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Affiliation(s)
- Bashir Alaour
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Masaaki Nakase
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Troger F, Lechner I, Reindl M, Tiller C, Holzknecht M, Pamminger M, Kremser C, Schwaiger J, Reinstadler SJ, Bauer A, Metzler B, Mayr A, Klug G. A novel approach to determine aortic valve area with phase-contrast cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2022; 24:7. [PMID: 34986847 PMCID: PMC8734220 DOI: 10.1186/s12968-021-00838-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/15/2021] [Indexed: 12/31/2022] Open
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 cm2), correlated moderately (r: 0.54, p < 0.001) with invasive AVA (0.70 ± 0.23 cm2), resulting in a small bias of 0.08 cm2 (LLoA and ULoA: - 0.36 cm2 and 0.55 cm2, p = 0.017). Inter-methodically, AVA by TTE (0.81 ± 0.23 cm2) compared to invasive determination showed similar correlations (r: 0.58, p < 0.001 with a bias of 0.11 cm2, 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.
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Affiliation(s)
- Felix Troger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christian Kremser
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Johannes Schwaiger
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Woldendorp K, Bannon PG, Grieve SM. Evaluation of aortic stenosis using cardiovascular magnetic resonance: a systematic review & meta-analysis. J Cardiovasc Magn Reson 2020; 22:45. [PMID: 32536342 PMCID: PMC7294634 DOI: 10.1186/s12968-020-00633-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 05/08/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As the average age of patients with severe aortic stenosis (AS) who receive procedural intervention continue to age, the need for non-invasive modalities that provide accurate diagnosis and operative planning is increasingly important. Advances in cardiovascular magnetic resonance (CMR) over the past two decades mean it is able to provide haemodynamic data at the aortic valve, along with high fidelity anatomical imaging. METHODS Electronic databases were searched for studies comparing CMR to transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) in the diagnosis of AS. Studies were included only if direct comparison was made on matched patients, and if diagnosis was primarily through measurement of aortic valve area (AVA). RESULTS Twenty-three relevant, prospective articles were included in the meta-analysis, totalling 1040 individual patients. There was no significant difference in AVA measured as by CMR compared to TEE. CMR measurements of AVA size were larger compared to TTE by an average of 10.7% (absolute difference: + 0.14cm2, 95% CI 0.07-0.21, p < 0.001). Reliability was high for both inter- and intra-observer measurements (0.03cm2 +/- 0.04 and 0.02cm2 +/- 0.01, respectively). CONCLUSIONS Our analysis demonstrates the equivalence of AVA measurements using CMR compared to those obtained using TEE. CMR demonstrated a small but significantly larger AVA than TTE. However, this can be attributed to known errors in derivation of left ventricular outflow tract size as measured by TTE. By offering additional anatomical assessment, CMR is warranted as a primary tool in the assessment and workup of patients with severe AS who are candidates for surgical or transcatheter intervention.
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Affiliation(s)
- Kei Woldendorp
- Sydney Translational Imaging Laboratory, Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006 Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW 2050 Australia
- Baird Institute of Applied Heart & Lung Surgical Research, Newtown, NSW 2042 Australia
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2006 Australia
| | - Paul G. Bannon
- Sydney Translational Imaging Laboratory, Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006 Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW 2050 Australia
- Baird Institute of Applied Heart & Lung Surgical Research, Newtown, NSW 2042 Australia
| | - Stuart M. Grieve
- Sydney Translational Imaging Laboratory, Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006 Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW 2050 Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW 2006 Australia
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Goebel J, Nensa F, Schemuth HP, Maderwald S, Schlosser T, Orzada S, Rietsch S, Quick HH, Nassenstein K. Feasibility of aortic valve planimetry at 7 T ultrahigh field MRI: Comparison to aortic valve MRI at 3 T and 1.5 T. Eur J Radiol Open 2018; 5:159-164. [PMID: 30225274 PMCID: PMC6138940 DOI: 10.1016/j.ejro.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction This study examined the feasibility of aortic valve planimetry at 7 T ultrahigh field MRI in intraindividual comparison to 3 T and 1.5 T MRI. Material and methods Aortic valves of eleven healthy volunteers (mean age, 26.4 years) were examined on a 7 T, 3 T, and 1.5 T MR system using FLASH and TrueFISP sequences. Two experienced radiologists evaluated overall image quality, the presence of artefacts, tissue contrast ratios, identifiability, and image details of the aortic valve opening area (AVOA). Furthermore, AVOA was quantified twice by reader 1 and once by reader 2. Correlation analysis between artefact severity and employed magnetic field strength was performed by modified Fisher’s exact-test. Paired t-test was used to analyse for AVOA differences, and Bland-Altman plots were used to analyse AVOA intra-rater and inter-rater variability. Results Aortic valve imaging at 7 T, 3 T, and 1.5 T with using FLASH was less hampered by artefacts than TrueFISP imaging at 3 T and 1.5 T. Tissue contrast and image details were rated best at 7 T. AVOA was measured slightly smaller at 7 T compared to 3 T (TrueFISP, p-value = 0.057; FLASH, p-value = 0.016) and 1.5 T (TrueFISP, p-value = 0.029; FLASH, p-value = 0.018). Intra-rater and inter-rater variability of AVOA tended to be slightly smaller at 7 T than at 3 T and 1.5 T. Conclusion Aortic valve planimetry at 7 T ultrahigh field MRI is technically feasible and in healthy volunteers offers an improved tissue contrast and a slightly better reproducibility than MR planimetry at 1.5 T and 3 T.
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Affiliation(s)
- Juliane Goebel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Haemi P Schemuth
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Thomas Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Stephan Orzada
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Stefan Rietsch
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany.,High Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Grading of aortic stenosis severity: a head-to-head comparison between cardiac magnetic resonance imaging and echocardiography. Radiol Med 2018; 123:643-654. [PMID: 29730841 DOI: 10.1007/s11547-018-0895-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/20/2018] [Indexed: 12/26/2022]
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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Lalude OO, Lerakis S. Cardiovascular Magnetic Resonance Imaging. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Stamatios Lerakis
- Emory University School of Medicine and Georgia Institute of Technology; Atlanta GA USA
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Wong S, Spina R, Toemoe S, Dhital K. Is cardiac magnetic resonance imaging as accurate as echocardiography in the assessment of aortic valve stenosis?: Table 1:. Interact Cardiovasc Thorac Surg 2015; 22:480-6. [DOI: 10.1093/icvts/ivv362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 11/12/2015] [Indexed: 11/13/2022] Open
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Buchner S, Debl K, Schmid FX, Luchner A, Djavidani B. Cardiovascular magnetic resonance assessment of the aortic valve stenosis: an in vivo and ex vivo study. BMC Med Imaging 2015; 15:34. [PMID: 26306577 PMCID: PMC4548454 DOI: 10.1186/s12880-015-0076-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/11/2015] [Indexed: 11/25/2022] Open
Abstract
Background Aortic valve area (AVA) estimation in patients with aortic stenosis may be obtained using several methods. This study was undertaken to verify the cardiovascular magnetic resonance (CMR) planimetry of aortic stenosis by comparing the findings with invasive catheterization, transthoracic (TTE) as well as tranesophageal echocardiography (TEE) and anatomic CMR examination of autopsy specimens. Methods Our study was performed in eight patients with aortic valve stenosis. Aortic stenosis was determined by TTE and TEE as well as catheterization and CMR. Especially, after aortic valve replacement, the explanted aortic valves were examined again with CMR ex vivo model. Results The mean AVA determined in vivo by CMR was 0.75 ± 0.09 cm2 and ex vivo by CMR was 0.65 ± 0.09 cm2 and was closely correlated (r = 0.91, p < 0.001). The mean absolute difference between AVA derived by CMR ex vivo and in vivo was −0.10 ± 0.04 cm2. The mean AVA using TTE was 0.69 ± 0.07 with a significant correlation between CMR ex vivo (r = 0.85, p < 0.007) and CMR in vivo (r = 0.86, p < 0.008). CMR ex vivo and in vivo had no significant correlation with AVA using Gorlin formula by invasive catheterization or using planimetry by TEE. Conclusion In this small study using an ex vivo aortic valve stenosis model, the aortic valve area can be reliably planimetered by CMR in vivo and ex vivo with a well correlation between geometric AVA by CMR and the effective AVA calculated by TTE.
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Affiliation(s)
- Stefan Buchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
| | - Kurt Debl
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
| | - Franz-Xaver Schmid
- Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany.
| | - Andreas Luchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
| | - Behrus Djavidani
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany.
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Renker M, Varga-Szemes A, Schoepf UJ, Baumann S, Piccini D, Zenge MO, Rehwald WG, Müller E, Rier JD, Möllmann H, Hamm CW, Steinberg DH, De Cecco CN. A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept. Eur Radiol 2015; 26:951-8. [PMID: 26188657 DOI: 10.1007/s00330-015-3906-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/23/2015] [Accepted: 06/29/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Due to the high prevalence of renal failure in transcatheter aortic valve replacement (TAVR) candidates, a non-contrast MR technique is desirable for pre-procedural planning. We sought to evaluate the feasibility of a novel, non-contrast, free-breathing, self-navigated three-dimensional (SN3D) MR sequence for imaging the aorta from its root to the iliofemoral run-off in comparison to non-contrast two-dimensional-balanced steady-state free-precession (2D-bSSFP) imaging. METHODS SN3D [field of view (FOV), 220-370 mm(3); slice thickness, 1.15 mm; repetition/echo time (TR/TE), 3.1/1.5 ms; and flip angle, 115°] and 2D-bSSFP acquisitions (FOV, 340 mm; slice thickness, 6 mm; TR/TE, 2.3/1.1 ms; flip angle, 77°) were performed in 10 healthy subjects (all male; mean age, 30.3 ± 4.3 yrs) using a 1.5-T MRI system. Aortic root measurements and qualitative image ratings (four-point Likert-scale) were compared. RESULTS The mean effective aortic annulus diameter was similar for 2D-bSSFP and SN3D (26.7 ± 0.7 vs. 26.1 ± 0.9 mm, p = 0.23). The mean image quality of 2D-bSSFP (4; IQR 3-4) was rated slightly higher (p = 0.03) than SN3D (3; IQR 2-4). The mean total acquisition time for SN3D imaging was 12.8 ± 2.4 min. CONCLUSIONS Our results suggest that a novel SN3D sequence allows rapid, free-breathing assessment of the aortic root and the aortoiliofemoral system without administration of contrast medium. KEY POINTS • The prevalence of renal failure is high among TAVR candidates. • Non-contrast 3D MR angiography allows for TAVR procedure planning. • The self-navigated sequence provides a significantly reduced scanning time.
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Affiliation(s)
- Matthias Renker
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine I, University Hospital Giessen and Marburg, Giessen, Germany
| | - Akos Varga-Szemes
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | - U Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA.
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Ashley River Tower, Charleston, SC, 29425-2260, USA.
| | - Stefan Baumann
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
- 1st Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Davide Piccini
- Advanced Clinical Imaging Technology, Siemens Healthcare IM BM PI, Lausanne, Switzerland
- Department of Radiology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Wolfgang G Rehwald
- Cardiovascular MR Center, Duke University Medical Center, Durham, NC, USA
| | - Edgar Müller
- Siemens AG, Healthcare Sector, Erlangen, Germany
| | - Jeremy D Rier
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Christian W Hamm
- Department of Medicine I, University Hospital Giessen and Marburg, Giessen, Germany
| | - Daniel H Steinberg
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
| | - Carlo N De Cecco
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy
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McRee CW, Ray JC, Shapiro BP. 78-year-old-woman with dyspnea on exertion. Mayo Clin Proc 2014; 89:e109-13. [PMID: 25444495 DOI: 10.1016/j.mayocp.2014.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/15/2014] [Accepted: 04/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Chad W McRee
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Jacksonville, FL
| | - Jordan C Ray
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Jacksonville, FL
| | - Brian P Shapiro
- Advisor to residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL.
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Kim SS, Ko SM, Song MG, Chee HK, Kim JS, Hwang HK, Lee JH. Quantification of stenotic mitral valve area and diagnostic accuracy of mitral stenosis by dual-source computed tomography in patients with atrial fibrillation: comparison with cardiovascular magnetic resonance and transthoracic echocardiography. Int J Cardiovasc Imaging 2014; 31 Suppl 1:103-14. [DOI: 10.1007/s10554-014-0488-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/03/2014] [Indexed: 11/27/2022]
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13
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Rajani R, Khattar R, Chiribiri A, Victor K, Chambers J. Multimodality imaging of heart valve disease. Arq Bras Cardiol 2014; 103:251-63. [PMID: 24830387 PMCID: PMC4193073 DOI: 10.5935/abc.20140057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/07/2014] [Indexed: 11/22/2022] Open
Abstract
Unidentified heart valve disease is associated with a significant morbidity and
mortality. It has therefore become important to accurately identify, assess and
monitor patients with this condition in order that appropriate and timely
intervention can occur. Although echocardiography has emerged as the predominant
imaging modality for this purpose, recent advances in cardiac magnetic resonance and
cardiac computed tomography indicate that they may have an important contribution to
make. The current review describes the assessment of regurgitant and stenotic heart
valves by multimodality imaging (echocardiography, cardiac computed tomography and
cardiac magnetic resonance) and discusses their relative strengths and
weaknesses.
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Affiliation(s)
- Ronak Rajani
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
| | - Rajdeep Khattar
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- Divisions of Imaging Sciences, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom
| | - Kelly Victor
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
| | - John Chambers
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
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Affiliation(s)
- Neelakantan Saikrishnan
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| | - Gautam Kumar
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| | - Fadi J. Sawaya
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| | - Stamatios Lerakis
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| | - Ajit P. Yoganathan
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
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Barone-Rochette G, Piérard S, Seldrum S, de Meester de Ravenstein C, Melchior J, Maes F, Pouleur AC, Vancraeynest D, Pasquet A, Vanoverschelde JL, Gerber BL. Aortic Valve Area, Stroke Volume, Left Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis Assessed by Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2013; 6:1009-17. [DOI: 10.1161/circimaging.113.000515] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gilles Barone-Rochette
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Sophie Piérard
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Stéphanie Seldrum
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Christophe de Meester de Ravenstein
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Julie Melchior
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Frédéric Maes
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Anne-Catherine Pouleur
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - David Vancraeynest
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Agnes Pasquet
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Jean-Louis Vanoverschelde
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Bernhard L. Gerber
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
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Muzzarelli S, Monney P, O'Brien K, Faletra F, Moccetti T, Vogt P, Schwitter J. Quantification of aortic flow by phase-contrast magnetic resonance in patients with bicuspid aortic valve. Eur Heart J Cardiovasc Imaging 2013; 15:77-84. [DOI: 10.1093/ehjci/jet129] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dimitriou P, Kähäri A, Emilsson K, Thunberg P. Cardiovascular magnetic resonance imaging and transthoracic echocardiography in the assessment of stenotic aortic valve area: a comparative study. Acta Radiol 2012; 53:995-1003. [PMID: 22983258 DOI: 10.1258/ar.2012.120261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Magnetic resonance (MR) imaging and echocardiography both allow assessment of aortic valve stenosis. In MR the aortic valve area (AvA) is measured using planimetry while in transthoracic echocardiography (TTE) AvA is usually calculated by applying the continuity equation. PURPOSE To compare the measured stenotic aortic valve areas using five different MR-acquisition alternatives with the corresponding area values calculated by TTE. MATERIAL AND METHODS The aortic valve was imaged in 14 patients, with diagnosed aortic valve stenosis, using balanced steady state free precession (bSSFP) gradient echo (GE) and phase contrast imaging (PC). Three adjacent slices were planned to encompass the aortic valve and the aortic valve area was measured using planimetry. The two sets of complex valued images generated by the PC sequence formed three kinds of images that could be used for aortic valve area measurements: the magnitude image (PC/Mag), the modulus (PCA/M), and phase difference (PCA/P) between the two complex images, respectively. The valve area from TTE was calculated using the continuity equation. A cut-off of <1.0 cm(2) was used as a criteria for severe stenosis. RESULTS The mean area differences between the different MR acquisitions and TTE method were -0.05 ± 0.37 cm(2) (GE), -0.18 ± 0.46 cm(2) (bSSFP), 0.27 ± 0.43 cm(2) (PC/Mag), 0.15 ± 0.32 cm(2) (PCA/P), and 0.26 ± 0.27 cm(2) (PCA/M). The valve area was significantly overestimated using PCA/M that, in turn, implied a significant underestimation of the aortic valve stenosis severity compared to the assessments using TTE. CONCLUSION The smallest area valve difference between TTE and an MR-acquisition alternative is obtained with gradient echo images. The use of PCA/M leads to significant differences in planimetry measurements of the aortic valve orifice and the gradation of the stenosis severity compared to TTE.
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Affiliation(s)
| | | | - Kent Emilsson
- Department of Clinical Physiology, Örebro University Hospital
- School of Health and Medical Sciences, Örebro University
| | - Per Thunberg
- School of Health and Medical Sciences, Örebro University
- Department of Medical Physics, Örebro University Hospital, Sweden
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Lee SC, Ko SM, Song MG, Shin JK, Chee HK, Hwang HK. Morphological assessment of the aortic valve using coronary computed tomography angiography, cardiovascular magnetic resonance, and transthoracic echocardiography: comparison with intraoperative findings. Int J Cardiovasc Imaging 2012; 28 Suppl 1:33-44. [PMID: 22592485 DOI: 10.1007/s10554-012-0066-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/04/2012] [Indexed: 12/19/2022]
Abstract
To compare the diagnostic accuracies of coronary computed tomography angiography (CCTA), cardiovascular magnetic resonance (CMR), and transthoracic echocardiography (TTE) in aortic valve (AV) morphological assessments with operative findings. We retrospectively enrolled 262 patients who underwent CCTA, CMR, and TTE before AV surgery. Two independent blinded observers assessed AV morphology as being tricuspid, bicuspid, or quadricuspid using three imaging modalities. Interobserver and intermodality agreements were obtained with kappa statistics. The diagnostic accuracies of CCTA, CMR, and TTE for identifying AV morphology (tricuspid vs. non-tricuspid) were compared with intraoperative findings as the reference standard. At surgery, tricuspid AV, bicuspid AV, and quadricuspid AV were present in 179, 80, and 3 patients, respectively. The CCTA and CMR image qualities were all diagnostic. Thirteen cases of TTE were not evaluable due to severe AV calcification. An excellent correlation between CMR and CCTA was seen for the identification of AV morphology (κ = 0.97). Good correlations existed between CCTA and TTE (κ = 0.72) and between CMR and TTE (κ = 0.74). CCTA, CMR, and TTE had an excellent or good interobserver agreement (κ = 0.90, 0.95, and 0.72, respectively). Sensitivity, specificity, and positive and negative predictive values for AV morphology assessment (tricuspid vs. non-tricuspid) were: 97, 95, 98, and 94 % with CCTA (n = 262); 98, 96, 98, and 95 % with CMR (n = 262); and 98, 88, 95, and 96 % with TTE (n = 249). CCTA and CMR are highly accurate for identifying AV morphology.
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Affiliation(s)
- Seung Choul Lee
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea
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Sommer G, Bremerich J, Lund G. Magnetic resonance imaging in valvular heart disease: Clinical application and current role for patient management. J Magn Reson Imaging 2012; 35:1241-52. [DOI: 10.1002/jmri.23544] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Son JY, Ko SM, Choi JW, Song MG, Hwang HK, Lee SJ, Kang JW. Measurement of the ascending aorta diameter in patients with severe bicuspid and tricuspid aortic valve stenosis using dual-source computed tomography coronary angiography. Int J Cardiovasc Imaging 2011; 27 Suppl 1:61-71. [DOI: 10.1007/s10554-011-9956-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/04/2011] [Indexed: 11/28/2022]
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Buchner S, Poschenrieder F, Hamer OW, Jungbauer C, Resch M, Birner C, Fellner C, Riegger GA, Stroszczynski C, Djavidani B, Debl K, Luchner A. Direct Visualization of Regurgitant Orifice by CMR Reveals Differential Asymmetry According to Etiology of Mitral Regurgitation. JACC Cardiovasc Imaging 2011; 4:1088-96. [DOI: 10.1016/j.jcmg.2011.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/16/2011] [Accepted: 06/16/2011] [Indexed: 12/01/2022]
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Assessment of Mitral Valve Stenosis by Helical MDCT: Comparison With Transthoracic Doppler Echocardiography and Cardiac Catheterization. AJR Am J Roentgenol 2011; 197:614-22. [PMID: 21862803 DOI: 10.2214/ajr.10.5132] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Assessment of Valvular Heart Disease by Cardiovascular Magnetic Resonance Imaging: A Review. Heart Lung Circ 2011; 20:73-82. [DOI: 10.1016/j.hlc.2010.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/16/2010] [Accepted: 08/31/2010] [Indexed: 12/17/2022]
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Sagmeister F, Herrmann S, Ritter C, Machann W, Köstler H, Hahn D, Voelker W, Weidemann F, Beer M. [Functional cardiac MRI for assessment of aortic valve disease]. Radiologe 2010; 50:541-7. [PMID: 20521022 DOI: 10.1007/s00117-010-1988-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aortic valve disease shows a rising incidence with the increasing mean age of Western populations. The detection of hemodynamic parameters, which transcends the mere assessment of valve morphology, has an important future potential concerning classification of the severity of disease. MRI allows a non-invasive and a spatially flexible view of the aortic valve and the adjacent anatomic region, left ventricular outflow tract (LVOT) and ascending aorta. Moreover, the technique allows the determination of functional hemodynamic parameters, such as flow velocities and effective orifice areas. The new approach of a serial systolic planimetry velocity-encoded MRI sequence (VENC-MRI) facilitates the sizing of blood-filled cardiac structures with the registration of changes in magnitude during systole. Additionally, the subvalvular VENC-MRI measurements improve the clinically important exact determination of the LVOT area with respect to its specific eccentric configuration and its systolic deformity.
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Affiliation(s)
- F Sagmeister
- Institut für Röntgendiagnostik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland.
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Samman A. Cardiac Imaging Integration in 2009 and Beyond: Cardiovascular magnetic resonance. J Saudi Heart Assoc 2009; 21:255-6. [DOI: 10.1016/j.jsha.2009.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Planimetry of the aortic valve orifice area: comparison of multislice spiral computed tomography and magnetic resonance imaging. Eur J Radiol 2009; 77:426-35. [PMID: 19783394 DOI: 10.1016/j.ejrad.2009.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 08/17/2009] [Accepted: 08/25/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to determine the comparability of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) for measuring the aortic valve orifice area (AVA) and grading aortic valve stenosis. MATERIALS AND METHODS Twenty-seven individuals, among them 18 patients with valvular stenosis, underwent AVA planimetry by both MSCT and MRI. In the subset of patients with valvular stenosis, AVA was also calculated from transthoracic Doppler echocardiography (TTE) using the continuity equation. RESULTS There was excellent correlation between MSCT and MRI (r = 0.99) and limits of agreement were in an acceptable range (± 0.42 cm(2)) although MSCT yielded a slightly smaller mean AVA than MRI (1.57 ± 0.83 cm(2) vs. 1.67 ± 0.98 cm(2), p < 0.05). However, in the subset of patients with valvular stenosis, the mean AVA was not different between MSCT and MRI (1.05 ± 0.30 cm(2) vs. 1.04 ± 0.39 cm(2); p > 0.05). The mean AVAs on both MSCT and MRI were systematically larger than on TTE (0.88 ± 0.28 cm(2), p < 0.001 each). Using an AVA of 1.0 cm(2) on TTE as reference, the best threshold for detecting severe-to-critical stenosis on MSCT and MRI was an AVA of 1.25 cm(2) and 1.30 cm(2), respectively, resulting in an accuracy of 96% each. CONCLUSION Our study specifies recent reports on the suitability of MSCT for quantifying AVA. The data presented here suggest that certain methodical discrepancies of AVA measurements exist between MSCT, MRI and TTE. However, MSCT and MRI have shown excellent correlation in AVA planimetry and similar accuracy in grading aortic valve stenosis.
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Cardiac magnetic resonance imaging findings are useful for differentiating between hypertrophic obstructive cardiomyopathy and aortic valve stenosis in elderly patients. J Comput Assist Tomogr 2009; 33:354-8. [PMID: 19478626 DOI: 10.1097/rct.0b013e3181857920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess whether cardiac magnetic resonance (MR) imaging is useful for differentiating between hypertrophic obstructive cardiomyopathy (HOCM) and aortic valve stenosis (AS) in 21 elderly patients (>75 years old). METHODS Cine and delayed contrast-enhanced cardiac MR imaging was performed and used to assess the regional wall thickness, myocardial mass, mitral valve motion, and myocardial hyperenhancement in elderly patients with HOCM and AS. RESULTS The basal anterior septal and midventricular inferior septal walls were significantly thicker, the ejection fraction was higher, and the ratio between the basal and midventricular inferior wall thicknesses was lower in patients with HOCM than those in patients with AS. Apical wall thinning and abnormal mitral valve motion were detected in patients with HOCM. CONCLUSIONS Structural and functional parameters that are characteristic of HOCM can be assessed in cardiac MR imaging, and these parameters may be useful for differentiating between HOCM and AS in elderly patients.
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Buchner S, Debl K, Haimerl J, Djavidani B, Poschenrieder F, Feuerbach S, Riegger GAJ, Luchner A. Electrocardiographic diagnosis of left ventricular hypertrophy in aortic valve disease: evaluation of ECG criteria by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11:18. [PMID: 19486532 PMCID: PMC2696426 DOI: 10.1186/1532-429x-11-18] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 06/01/2009] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality. The purpose was to evaluate different electrocardiographic criteria for LVH as determined by cardiovascular magnetic resonance (CMR). Additionally, the effects of concentric and eccentric LVH on depolarization and repolarization were assessed. METHODS 120 patients with aortic valve disease and 30 healthy volunteers were analysed. As ECG criteria for LVH, we assessed the Sokolow-Lyon voltage/product, Gubner-Ungerleider voltage, Cornell voltage/product, Perugia-score and Romhilt-Estes score. RESULTS All ECG criteria demonstrated a significant correlation with LV mass and chamber size. The highest predictive values were achieved by the Romhilt-Estes score 4 points with a sensitivity of 86% and specificity of 81%. There was no difference in all ECG criteria between concentric and eccentric LVH. However, the intrinsicoid deflection (V6 37 +/- 1.0 ms vs. 43 +/- 1.6 ms, p < 0.05) was shorter in concentric LVH than in eccentric LVH and amplitudes of ST-segment (V5 -0.06 +/- 0.01 vs. -0.02 +/- 0.01) and T-wave (V5 -0.03 +/- 0.04 vs. 0.18 +/- 0.05) in the anterolateral leads (p < 0.05) were deeper. CONCLUSION By calibration with CMR, a wide range of predictive values was found for the various ECG criteria for LVH with the most favourable results for the Romhilt-Estes score. As electrocardiographic correlate for concentric LVH as compared with eccentric LVH, a shorter intrinsicoid deflection and a significant ST-segment and T-wave depression in the anterolateral leads was noted.
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Affiliation(s)
- Stefan Buchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Kurt Debl
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Josef Haimerl
- Medizinische Klinik, Klinikum Landshut Achdorf, Germany
| | - Behrus Djavidani
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Germany
| | | | - Stefan Feuerbach
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Germany
| | - Guenter AJ Riegger
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Andreas Luchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
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30
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Affiliation(s)
- Peter J. Cawley
- From the Division of Cardiology (P.J.C., C.M.O.), Department of Medicine, and Department of Radiology (J.H.M.), University of Washington, Seattle, Wash
| | - Jeffrey H. Maki
- From the Division of Cardiology (P.J.C., C.M.O.), Department of Medicine, and Department of Radiology (J.H.M.), University of Washington, Seattle, Wash
| | - Catherine M. Otto
- From the Division of Cardiology (P.J.C., C.M.O.), Department of Medicine, and Department of Radiology (J.H.M.), University of Washington, Seattle, Wash
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31
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Dilatation of the ascending aorta in bicuspid aortic valve disease: a magnetic resonance imaging study. Clin Res Cardiol 2008; 98:114-20. [PMID: 19083040 DOI: 10.1007/s00392-008-0731-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 09/18/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bicuspid aortic valve disease (BAV) is increasingly recognized as a disease of the entire proximal aorta including both valvular and vascular complications. The aim of our study was to assess the dimensions of the thoracic aorta using MRI in a broad spectrum of BAV and tricuspid aortic valve disease (TAV) and to define the prevalence of the dilatation of the ascending aorta (AA) >or= 4.5 cm in severe BAV disease. METHODS AND RESULTS MRI studies were performed on a 1.5 T scanner in a total of 195 consecutive patients with aortic valve disease. Eighty-four aortic valves were classified as BAV and 103 as TAV. In 8 patients, classification of the aortic valve was not possible due to poor image quality. Mean diameters of the AA were significantly greater in BAV compared to TAV (4.39+/-0.85 Vs. 3.55+/-0.47 cm, P<0.0001), whereas no differences were observed in the mean diameters of the aortic arch. Diameters of the descending aorta were slightly smaller in BAV compared to TAV (2.45+/-0.43 Vs. 2.58+/-0.31 cm, P<0.05). In BAV, AA dilatation was independent of the severity of valve dysfunction. In TAV, aortic regurgitation but not stenosis correlated weakly with AA dilatation. Prevalence of AA dilatation >or= 4.5 cm in BAV with severe aortic stenosis and regurgitation was 38% and 41%, respectively. CONCLUSION Dilatation of the proximal aorta is a frequent finding in BAV and independent of the severity of valve dysfunction. With respect to the high prevalence of AA dilatation >or= 4.5 cm in BAV with severe valve dysfunction, careful assessment of the dimensions of the AA is crucial to identify patients in whom concomitant AA replacement is indicated according to current guidelines.
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Aortic Valve Area on 64-MDCT Correlates with Transesophageal Echocardiography in Aortic Stenosis. AJR Am J Roentgenol 2008; 191:1652-8. [DOI: 10.2214/ajr.07.3703] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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33
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Precision of Forty Slice Spiral Computed Tomography for Quantifying Aortic Valve Stenosis. Invest Radiol 2008; 43:719-28. [DOI: 10.1097/rli.0b013e318184d7c5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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34
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Buchner S, Debl K, Poschenrieder F, Feuerbach S, Riegger GA, Luchner A, Djavidani B. Cardiovascular Magnetic Resonance for Direct Assessment of Anatomic Regurgitant Orifice in Mitral Regurgitation. Circ Cardiovasc Imaging 2008; 1:148-55. [DOI: 10.1161/circimaging.107.753103] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In patients with mitral regurgitation (MR), assessment of the severity of valvular dysfunction is crucial. Recently, regurgitant orifice area has been proposed as the most useful indicator of the severity of MR. The purpose of our study was to determine whether planimetry of the anatomic regurgitant orifice (ARO) in patients with MR is feasible by cardiovascular magnetic resonance (CMR) and correlates with invasive catheterization and echocardiography effective regurgitant orifice [ECHO-ERO] by proximal isovelocity surface area.
Methods and Results—
Planimetry of ARO was performed with a 1.5-T CMR scanner using a breath-hold balanced gradient echo sequence true fast imaging with steady state precession (TrueFISP). CMR planimetry of ARO was possible in 35 of 38 patients and was closely correlated with angiographic grading (
r
=0.84,
P
<0.0001). In patients with MR grade ≥III on catheterization, CMR-ARO (0.60�0.29 cm
2
versus 0.30�0.19 cm
2
,
P
<0.0001) as well as ECHO-ERO (0.49�0.17 cm
2
versus 0.27�0.10 cm
2
) were significantly elevated in comparison with MR grade <III. Further, CMR-ARO was closely correlated to CMR regurgitant fraction and volume (
r
=0.90 and
r
=0.91,
P
<0.0001, respectively) and catheterization regurgitant fraction and volume (
r
=0.86 and 0.83,
P
<0.0001, respectively). The correlation between CMR-ARO and ECHO-ERO was 0.81 (
P
<0.0001) and CMR slightly overestimated ECHO-ERO by 0.06 cm
2
(
P
<0.05). As assessed by receiver operating characteristic analysis, CMR-ARO at a threshold of 0.40 cm
2
detected MR grade ≥III as defined by catheterization, with a sensitivity and specificity of 94% and 94%, respectively.
Conclusion—
CMR planimetry of the anatomic mitral regurgitant lesion in patients with MR is feasible and permits quantification of MR with good agreement with the accepted invasive and noninvasive methods. Direct measurement by CMR is a promising new method for the precise assessment of ARO area and the severity of MR.
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Affiliation(s)
- Stefan Buchner
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Kurt Debl
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Florian Poschenrieder
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Stefan Feuerbach
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Günter A.J. Riegger
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Andreas Luchner
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Behrus Djavidani
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
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Pouleur AC, le Polain de Waroux JB, Pasquet A, Vanoverschelde JLJ, Gerber BL. Aortic valve area assessment: multidetector CT compared with cine MR imaging and transthoracic and transesophageal echocardiography. Radiology 2007; 244:745-54. [PMID: 17630357 DOI: 10.1148/radiol.2443061127] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To prospectively compare the accuracy of multidetector computed tomographic (CT) measurements of the aortic valve area (AVA) with transesophageal echocardiography (TEE) and cine magnetic resonance (MR) measurements of this area for preoperative examination of patients undergoing cardiac surgery, with transthoracic echocardiography (TTE) as the reference standard. MATERIALS AND METHODS After giving informed consent for the institutional review board-approved study protocol, 48 patients (33 men, 15 women; mean age, 62 years+/-13 [standard deviation]) with (n=27) or without (n=21) aortic stenosis underwent multidetector CT, cine MR, TTE, and TEE before undergoing cardiac surgery. AVAs derived with manual planimetry by using cine short-axis multidetector CT, MR, and TEE images obtained through the aortic valve were compared among each other and with AVAs measured by using continuity equation TTE at regression and Bland-Altman analyses. The diagnostic accuracy of multidetector CT for detection of aortic stenosis was compared with that of TTE by using kappa statistics and receiver operating characteristic curves. RESULTS Multidetector CT-derived AVA correlated highly with MR-derived (r=0.98, P<.001), TEE-derived (r=0.98, P<.001), and TTE-derived (r=0.96, P<.001) AVA. Multidetector CT planimetry AVAs (mean AVA+/-standard deviation, 2.5 cm2+/-1.7) were not significantly different from MR planimetry (2.4 cm2+/-1.8, P>.99) or TEE planimetery (2.5 cm2+/-1.7, P=.21) AVAs, but they were significantly larger than TTE-derived AVAs (2.0 cm2+/-1.5, P<.001). With TTE as the reference standard, multidetector CT correctly (kappa=0.88, P<.001) depicted all 21 normal, six of eight mildly stenotic (AVA>or=1.2 cm2 and <2.0 cm2), seven of eight moderately stenotic (AVA>or= 0.8 cm2 and <1.2 cm2), and 10 of 11 severely stenotic (AVA<0.8 cm2) valves. It also correctly depicted all 14 bicuspid valves identified with TEE, eight of which were missed with TTE. CONCLUSION Multidetector CT enables accurate noninvasive assessment of the AVA.
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Affiliation(s)
- Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St Luc, Université Catholique de Louvain, Av Hippocrate 10/2806, B-1200 Woluwe St Lambert, Belgium
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Pouleur AC, le Polain de Waroux JB, Pasquet A, Vancraeynest D, Vanoverschelde JLJ, Gerber BL. Planimetric and continuity equation assessment of aortic valve area: Head to head comparison between cardiac magnetic resonance and echocardiography. J Magn Reson Imaging 2007; 26:1436-43. [DOI: 10.1002/jmri.21182] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Debl K, Djavidani B, Buchner S, Lipke C, Nitz W, Feuerbach S, Riegger G, Luchner A. Delayed hyperenhancement in magnetic resonance imaging of left ventricular hypertrophy caused by aortic stenosis and hypertrophic cardiomyopathy: visualisation of focal fibrosis. Heart 2006; 92:1447-51. [PMID: 16606864 PMCID: PMC1861032 DOI: 10.1136/hrt.2005.079392] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare the extent and distribution of focal fibrosis by gadolinium contrast-enhanced magnetic resonance imaging (MRI; delayed hyperenhancement) in severe left ventricular (LV) hypertrophy in patients with pressure overload caused by aortic stenosis (AS) and with genetically determined hypertrophic cardiomyopathy (HCM). METHODS 44 patients with symptomatic valvular AS (n = 22) and HCM (n = 22) were studied. Cine images were acquired with fast imaging with steady-state precession (trueFISP) on a 1.5 T scanner (Sonata, Siemens Medical Solutions). Gadolinium contrast-enhanced MRI was performed with a segmented inversion-recovery sequence. The location, extent and enhancement pattern of hyperenhanced myocardium was analysed in a 12-segment model. RESULTS Mean LV mass was 238.6 (SD 75.3) g in AS and 205.4 (SD 80.5) g in HCM (p = 0.17). Hyperenhancement was observed in 27% of patients with AS and in 73% of patients with HCM (p < 0.01). In AS, hyperenhancement was observed in 60% of patients with a maximum diastolic wall thickness >or= 18 mm, whereas no patient with a maximum diastolic wall thickness < 18 mm had hyperenhancement (p < 0.05). Patients with hyperenhancement had more severe AS than patients without hyperenhancement (aortic valve area 0.80 (0.09) cm(2)v 0.99 (0.3) cm(2), p < 0.05; maximum gradient 98 (22) mm Hg v 74 (24) mm Hg, p < 0.05). In HCM, hyperenhancement was predominant in the anteroseptal regions and patients with hyperenhancement had higher end diastolic (125.4 (36.9) ml v 98.8 (16.9) ml, p < 0.05) and end systolic volumes (38.9 (18.2) ml v 25.2 (1.7) ml, p < 0.05). The volume of hyperenhancement (percentage of total LV myocardium), where present, was lower in AS than in HCM (4.3 (1.9)% v 8.6 (7.4)%, p< 0.05). Hyperenhancement was observed in 4.5 (3.1) and 4.6 (2.7) segments in AS and HCM, respectively (p = 0.93), and the enhancement pattern was mostly patchy with multiple foci. CONCLUSIONS Focal scarring can be observed in severe LV hypertrophy caused by AS and HCM, and correlates with the severity of LV remodelling. However, focal scarring is significantly less prevalent in adaptive LV hypertrophy caused by AS than in genetically determined HCM.
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Affiliation(s)
- K Debl
- Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität, Regensburg, Germany
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