Key result
Pulse wave velocity estimated from 4D flow MRI accurately differentiated severe stable CAD patients from healthy controls with an AUC of 0.97, outperforming 2D flow MRI and applanation tonometry.
Why the study?
MRI tools to evaluate aortic stiffness may reach technical limitations in cardiovascular disease populations, prompting evaluation of the diagnostic value of applanation tonometry versus MRI in high-risk CAD patients.
Does 4D flow MRI-derived pulse wave velocity better differentiate severe stable CAD patients from healthy controls compared to 2D flow MRI, aortic distensibility, and applanation tonometry?
Case-Control (n=53)
No
Does 4D flow MRI-derived pulse wave velocity better differentiate severe stable CAD patients from healthy controls compared to 2D flow MRI, aortic distensibility, and applanation tonometry?
Effect estimate: AUC 0.97
Absolute Event Rate: 17.3% vs 8.7%
p-value: p=<0.001
4D flow MRI-derived pulse wave velocity outperforms 2D flow MRI, aortic distensibility, and applanation tonometry in identifying severe stable CAD patients from healthy controls.
Background and objective: Aortic stiffness can be evaluated by aortic distensibility or pulse wave velocity (PWV) using applanation tonometry, 2D phase contrast (PC) MRI and the emerging 4D flow MRI. However, such MRI tools may reach their technical limitations in populations with cardiovascular disease. Accordingly, this work focuses on the diagnostic value of aortic stiffness evaluated either by applanation tonometry or MRI in high-risk coronary artery disease (CAD) patients. Methods: 35 patients with a multivessel CAD and a myocardial infarction treated 1 year before were prospectively recruited and compared with 18 controls with equivalent age and sex distribution. Ascending aorta distensibility and aortic arch 2D PWV were estimated along with 4D PWV. Furthermore, applanation tonometry carotid-to-femoral PWV (cf PWV) was recorded immediately after MRI. Results: While no significant changes were found for aortic distensibility; cf PWV, 2D PWV and 4D PWV were significantly higher in CAD patients than controls (12.7 ± 2.9 vs. 9.6 ± 1.1; 11.0 ± 3.4 vs. 8.0 ± 2.05 and 17.3 ± 4.0 vs. 8.7 ± 2.5 m·s−1 respectively, p < 0.001). The receiver operating characteristic (ROC) analysis performed to assess the ability of stiffness indices to separate CAD subjects from controls revealed the highest area under the curve (AUC) for 4D PWV (0.97) with an optimal threshold of 12.9 m·s−1 (sensitivity of 88.6% and specificity of 94.4%). Conclusions: PWV estimated from 4D flow MRI showed the best diagnostic performances in identifying severe stable CAD patients from age and sex-matched controls, as compared to 2D flow MRI PWV, cf PWV and aortic distensibility.
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Nguyen et al. (2023) conducted a case-control in Coronary artery disease (n=53). 4D flow MRI pulse wave velocity (PWV) vs. 2D flow MRI, aortic distensibility, and carotid-to-femoral PWV was evaluated on Diagnostic performance (AUC) of 4D PWV to differentiate CAD patients from controls (AUC 0.97, p=<0.001). Pulse wave velocity estimated from 4D flow MRI accurately differentiated severe stable CAD patients from healthy controls with an AUC of 0.97, outperforming 2D flow MRI and applanation tonometry.
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