Clinical assessment of aortic valve stenosis: Comparison between 4D flow MRI and transthoracic echocardiography

Bouke P Adriaans; Jos J M Westenberg; Yvonne J M van Cauteren; Suzanne Gerretsen; Mohammed S M Elbaz; Sebastiaan C A M Bekkers; Leo F Veenstra; Harry J G M Crijns; Joachim E Wildberger; Simon Schalla

doi:10.1002/jmri.26847

Clinical assessment of aortic valve stenosis: Comparison between 4D flow MRI and transthoracic echocardiography

J Magn Reson Imaging. 2020 Feb;51(2):472-480. doi: 10.1002/jmri.26847. Epub 2019 Jun 30.

Authors

Bouke P Adriaans^{1

2

3}, Jos J M Westenberg⁴, Yvonne J M van Cauteren^{1

2

3}, Suzanne Gerretsen¹, Mohammed S M Elbaz⁵, Sebastiaan C A M Bekkers^{1

2

3}, Leo F Veenstra², Harry J G M Crijns^{2

3}, Joachim E Wildberger^{1

3}, Simon Schalla^{1

2

3}

Affiliations

¹ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
² Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
³ Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
⁴ Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
⁵ Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Abstract

Background: The prevalence of valvular aortic stenosis (AS) increases as the population ages. Echocardiographic measurements of peak jet velocity (V_peak ), mean pressure gradient (P_mean ), and aortic valve area (AVA) determine AS severity and play a pivotal role in the stratification towards valvular replacement. A multimodality imaging approach might be needed in cases of uncertainty about the actual severity of the stenosis.

Purpose: To compare four-dimensional phase-contrast magnetic resonance (4D PC-MR), two-dimensional (2D) PC-MR, and transthoracic echocardiography (TTE) for quantification of AS.

Study type: Prospective.

Population: Twenty patients with various degrees of AS (69.3 ± 5.0 years).

Field strength/sequences: 4D PC-MR and 2D PC-MR at 3T.

Assessment: We compared V_peak , P_mean , and AVA between TTE, 4D PC-MR, and 2D PC-MR. Flow eccentricity was quantified by means of normalized flow displacement, and its influence on the accuracy of TTE measurements was investigated.

Statistical tests: Pearson's correlation, Bland-Altman analysis, paired t-test, and intraclass correlation coefficient.

Results: 4D PC-MR measured higher V_peak (r = 0.95, mean difference + 16.4 ± 10.7%, P <0.001), and P_mean (r = 0.92, mean difference + 14.9 ± 16.0%, P = 0.013), but a less critical AVA (r = 0.80, mean difference + 19.9 ± 20.6%, P = 0.002) than TTE. In contrast, unidirectional 2D PC-MR substantially underestimated AS severity when compared with TTE. Differences in V_peak between 4D PC-MR and TTE showed to be strongly correlated with the eccentricity of the flow jet (r = 0.89, P <0.001). Use of 4D PC-MR improved the concordance between V_peak and AVA (from 0.68 to 0.87), and between PG_mean and AVA (from 0.68 to 0.86).

Data conclusion: 4D PC-MR improves the concordance between the different AS parameters and could serve as an additional imaging technique next to TTE. Future studies should address the potential value of 4D PC-MR in patients with discordant echocardiographic parameters.

Level of evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:472-480.

Keywords: 4D flow MRI; aortic stenosis; transthoracic echocardiography; valvular heart disease.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve* / diagnostic imaging
Echocardiography
Humans
Magnetic Resonance Imaging
Prospective Studies
Reproducibility of Results
Severity of Illness Index