Key result
CMR aliased orifice area planimetry strongly correlates with hybrid effective orifice area for grading AS.
Why the study?
TTE-derived EOA is operator-dependent and prone to errors from multiple measurements, prompting evaluation of aliased orifice area planimetry by low-VENC CMR for grading AS severity.
Does aliased orifice area planimetry by CMR accurately and precisely grade aortic stenosis severity compared to standard echocardiographic and hybrid methods in patients with suspected valvular heart disease?
Observational (n=28)
Does aliased orifice area planimetry by CMR accurately and precisely grade aortic stenosis severity compared to standard echocardiographic and hybrid methods in patients with suspected valvular heart disease?
Aliased orifice area planimetry by CMR is a highly accurate and reproducible non-invasive method for grading aortic stenosis severity, offering a reliable alternative when echocardiography is inconclusive.
Supports CMR planimetry as alternative for aortic stenosis grading when echocardiography inconclusive; leaves open prospective outcome validation.
Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOA cmr ), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOA cmr ; (ii) geometric orifice area (GOA cmr ) by direct CMR planimetry; (iii) EOA echo by TTE-continuity equation; and (iv) the “gold standard” multimodality EOA (EOA hybrid ) obtained by substituting CMR LVOT area into Doppler continuity equation. Results: There was excellent pairwise positive linear correlation among AOA cmr , EOA hybrid , GOA cmr , and EOA echo ( p < 0.001); AOA cmr had the highest correlation with EOA hybrid ( R 2 = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOA cmr and EOA hybrid . AOA cmr yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.
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Mantini et al. (2021) conducted an observational in Aortic stenosis (n=28). Aliased orifice area planimetry (AOACMR) by low-VENC phase-contrast CMR vs. Transthoracic echocardiography and multimodality hybrid EOA was evaluated on Agreement and correlation among AOACMR, GOACMR, EOAecho, and EOAhybrid (R2 = 0.985, p=< 0.001). Aliased orifice area planimetry by CMR showed excellent correlation with the multimodality hybrid effective orifice area (R2 = 0.985, p < 0.001) for grading aortic stenosis severity.
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