Key result
TTE, 2D, and 4D flow CMR provided reliable assessments after percutaneous pulmonary valve implantation, showing strong correlations for net flow (r=0.87) and regurgitation fraction (r=0.96).
Why the study?
The study aimed to compare transthoracic echocardiography (TTE), 2D, and 4D flow cardiovascular magnetic resonance (CMR) for evaluating valve function and flow measurements after percutaneous pulmonary valve implantation.
Do 2D and 4D flow CMR correlate with TTE for quantitative valve assessment in patients after percutaneous pulmonary valve implantation?
Do 2D and 4D flow CMR correlate with TTE for quantitative valve assessment in patients after percutaneous pulmonary valve implantation?
TTE, 2D, and 4D flow CMR are feasible and reliable imaging techniques for assessing valve function after percutaneous pulmonary valve implantation, particularly in mild-to-moderate stenosis.
Supports TTE and 4D flow CMR after PPVI in clinical practice; extends quantitative imaging options for mild-to-moderate stenosis.
Aim To compare transthoracic echocardiography (TTE), 2D and 4D flow cardiovascular magnetic resonance (CMR) for the evaluation of valve function and flow measurements after percutaneous pulmonary valve implantation (PPVI). Methods In this multicentre exploratory observational study, 29 patients who underwent PPVI were planned for TTE and CMR with 2D and 4D flow measurements after PPVI. Peak velocity was measured with all techniques. Net and regurgitating flow measurements were measured with CMR distal to the transcatheter pulmonary valve (TPV). Results Median peak velocity of the transcatheter pulmonary valve (TPV) with TTE was 2.5 (2.0-3.1) m/s, with 2D flow CMR 2.3 (2.0-3.2) m/s, and with 4D flow 2.3 (2.0-3.0) m/s. There was a good correlation for the peak velocity of the TPV between TTE and 2D flow CMR (r=0.68, p<0.001) and a moderate correlation for peak velocity between TTE and 4D flow CMR (r=0.56, p=0.003), and between 2D flow and 4D flow CMR (r=0.56, p=0.006). For peak velocity measurements, no proportional bias was observed between the three imaging techniques. For the CMR flow measurements, a strong correlation was observed between 2D and 4D flow CMR, for both net flow (r=0.87, p<0.001) and regurgitation fraction (r=0.96, p<0.001) of the TPV. Net flow through the left pulmonary artery correlated strongly between 2D and 4D flow CMR (r=0.85, p<0.001), and there was a good correlation for the right pulmonary artery (r=0.65, p<0.01). For net flow measurements of the TPV, we found an underestimation of flow measurements at higher flow rates with 4D flow CMR, compared to 2D flow CMR. Conclusion TTE, 2D and 4D flow CMR are all feasible and reliable imaging techniques after PPVI, concordant in predominantly mild-to-moderate stenosis. These findings strengthen the use of 2D and 4D flow CMR as a tool for post-PPVI assessment, despite stent induced artifacts, although reliability in more advanced valve dysfunction remains uncertain.
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Faure et al. (2026) studied this question. TTE, 2D, and 4D flow CMR provided reliable assessments after percutaneous pulmonary valve implantation, showing strong correlations for net flow (r=0.87) and regurgitation fraction (r=0.96).
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