Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Aortic stenosis (n=30). Intervention: 4D flow cardiovascular MRI vs. Transthoracic echocardiography. Primary outcome: Predicting aortic valve intervention (HR 2.51, p=<0.01).

Ciaran Grafton‐Clarke; Hosamadin Assadi; Rui Li; Zia Mehmood; Rimma Hall; Gareth Matthews; Vasiliki Tsampasian; Samer Alabed; Bahman Kasmai; Laura Staff; John J. Curtin; Gurung-Koney Yashoda; Julia Sun; Sunil Nair; David Hewson; Kurian Thampi; Jordi Broncano; Fabrizio Ricci; Peter Swoboda; Andrew J. Swift; Vassilios S. Vassiliou; Rob J. van der Geest; Pankaj Garg

doi:10.1136/openhrt-2024-003081

Figures

Why the study?

Four-dimensional flow cardiovascular MRI has emerged for assessing aortic stenosis, but its agreement with transthoracic echocardiography in estimating peak velocities, grading severity, and predicting aortic valve intervention in real-world settings needed evaluation.

Does 4D flow CMR improve the prediction of aortic valve intervention compared to transthoracic echocardiography in patients with aortic stenosis?

Key Points

To evaluate the diagnostic agreement between 4D flow cardiovascular magnetic resonance and transthoracic echocardiography for measuring peak aortic valve velocities and predicting the need for valve intervention.
Interventional study (NCT05114785) evaluating 30 patients (mean age 75.4 years, 67% male) with aortic stenosis enrolled in the PREFER-CMR registry.
Participants underwent consecutive transthoracic echocardiography and 4D flow cardiovascular MRI, assessing aortic stenosis severity via peak aortic valve velocity (V Peak), valve area, and mean pressure gradient alongside Cox regression modeling.
Both continuous wave Doppler V Peak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V Peak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients requiring aortic valve intervention (n=17) compared to those who did not.
Continuous wave Doppler significantly underestimated peak velocity compared to 4D flow CMR, showing a bias of −0.5 m/s (p=0.01) and moderate correlation (R=0.55, p=0.002).
Multivariable Cox regression revealed that 4D flow V Peak significantly predicted aortic valve intervention (HR=2.51, p<0.01), whereas continuous wave Doppler V Peak did not (HR=0.54, p=0.76; overall model χ²=9.5, p=0.02).

Study Design

Type

Observational (n=30)

Structured PICO

Does 4D flow CMR improve the prediction of aortic valve intervention compared to transthoracic echocardiography in patients with aortic stenosis?

P

Population

30 patients from the PREFER-CMR registry with aortic stenosis who had consecutive TTE and 4D flow CMR, mean age 75.4 years, 67% male.

I

Intervention

Four-dimensional flow cardiovascular MRI (4D flow CMR)

C

Comparator

Transthoracic echocardiography (TTE) using continuous wave Doppler (CWD)

O

Outcome

Agreement in estimating peak aortic valve velocities (V Peak), grading AS severity, and predicting AV interventionsurrogate

Main Result

Effect estimate: HR 2.51

p-value: p=<0.01

4D flow CMR provides incremental diagnostic value over standard echocardiography by better predicting the need for aortic valve intervention in patients with aortic stenosis.

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Implication

4D flow CMR peak velocity may aid aortic stenosis risk stratification beyond echocardiography; leaves open need for prospective validation before clinical adoption.

Abstract

Aims Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (V Peak ), grading AS severity and predicting AV intervention in a real-world setting. Methods Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included. AS severity was graded using established protocols using three echocardiographic parameters (V Peak , AV area and mean pressure gradient) and CMR-derived V Peak . Results The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V Peak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V Peak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V Peak by CWD was significantly lower to 4D flow with a bias of −0.5 (p=0.01) and a correlation of (R=0.55, p=0.002). The Cox-regression analysis reveals that 4D flow V Peak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V Peak (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ²=9.5, p=0.02). Conclusion 4D flow CMR-derived V Peak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention. Trial registration number NCT05114785 .

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Cite This Study

Grafton‐Clarke et al. (2025) conducted an observational in Aortic stenosis (n=30). 4D flow cardiovascular MRI vs. Transthoracic echocardiography was evaluated on Predicting aortic valve intervention (HR 2.51, p=<0.01).

synapsesocial.com/papers/6a0d99e19a2918c675a4ed82 https://doi.org/10.1136/openhrt-2024-003081

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Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis

Figures

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis

Figures

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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