Aortic Valve Area and Strain Measurements by Cardiac MRI and Transthoracic Echocardiography in Severe Aortic Stenosis with Normal Left Ventricular Function.

Q: What are the key findings of this study?

Cardiac magnetic resonance demonstrated excellent agreement with transthoracic echocardiography for evaluating aortic valve area (ICC 0.932) and detecting subclinical myocardial strain impairment.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic stenosis with normal left ventricular function (n=48). Intervention: Cardiac magnetic resonance (CMR) vs. Transthoracic echocardiography (TTE). Primary outcome: Agreement between aortic valve area (AVA) values derived from CMR planimetry and TTE (ICC 0.932, 95% CI 0.829-0.973, p=<0.001).

Q: What does this research mean for the field?

Cardiac magnetic resonance demonstrates high agreement with transthoracic echocardiography for quantifying aortic valve area and reveals subclinical myocardial strain impairment in patients with severe aortic stenosis despite normal left ventricular ejection fraction. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate and compare aortic valve area and ventricular strain measurements obtained via transthoracic echocardiography and cardiac magnetic resonance in patients with severe aortic stenosis and preserved ejection fraction.

Nahid Rezaeian; Leila Hosseini; Niloufar Samiei; M H Azimian; Alireza Rashidinejad; Yaser Toloueitabar; Mohammad Mehdi Hemmati Komasi; Leila Shayan; Sanaz Asadian

doi:10.30476/ijms.2022.94552.2590

July 1, 2023Open Access

Aortic Valve Area and Strain Measurements by Cardiac MRI and Transthoracic Echocardiography in Severe Aortic Stenosis with Normal Left Ventricular Function.

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Key result

CMR shows excellent agreement with TTE for measuring aortic valve area and detecting strain impairment.

ICC 0.932
95% CI 0.829-0.973
P<0.001
n=48

Figures

Why the study?

Although TTE is recommended to evaluate AS, CMR planimetry is used when findings are inconclusive, warranting comparison between TTE and CMR in severe AS with normal LV function.

Does cardiac magnetic resonance (CMR) provide reliable aortic valve area and myocardial strain measurements compared to transthoracic echocardiography (TTE) in patients with severe aortic stenosis and normal LV function?

Key Points

To evaluate and compare aortic valve area and ventricular strain measurements obtained via transthoracic echocardiography and cardiac magnetic resonance in patients with severe aortic stenosis and preserved ejection fraction.
Assessed 20 patients with severe aortic stenosis and normal left ventricular function alongside 28 healthy controls.
Measured aortic valve area and myocardial strain parameters using transthoracic echocardiography and cardiac magnetic resonance planimetry and feature-tracking.
Aortic valve area measurements showed excellent agreement between cardiac magnetic resonance and transthoracic echocardiography (mean ICC=0.932, 95% CI=0.829-0.973, P<0.001).
Global longitudinal strain correlated well between modalities (ICC=0.721, 95% CI=0.255-0.896, P=0.006), with left ventricular global longitudinal strain significantly lower in aortic stenosis patients than controls (13.8±2.6% vs 18.1±1.3%, P<0.001).
Mean aortic valve pressure gradient from echocardiography displayed a significant inverse linear correlation with magnetic resonance left ventricular global radial strain (r=-0.537, P=0.01).

Study Design

Type

Observational (n=48)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does cardiac magnetic resonance (CMR) provide reliable aortic valve area and myocardial strain measurements compared to transthoracic echocardiography (TTE) in patients with severe aortic stenosis and normal LV function?

P

Population

48 adults (20 with severe symptomatic aortic stenosis and preserved LV function, and 28 healthy controls) who underwent same-day comparative imaging.

I

Intervention

Cardiac magnetic resonance (CMR) imaging including planimetry for aortic valve area and feature-tracking for myocardial strain measurement

C

Comparator

Transthoracic echocardiography (TTE) using the continuity equation for aortic valve area and speckle-tracking for myocardial strain

O

Outcome

Agreement in aortic valve area (AVA) values derived from CMR and TTEsurrogate

Main Result

Effect estimate: ICC 0.932 (95% CI 0.829-0.973)

p-value: p=<0.001

CMR serves as a reliable noninvasive alternative to TTE for measuring aortic valve area and can detect early subclinical myocardial dysfunction in severe aortic stenosis.

Limitations

Low sample size
Incomplete CMR assessment without late gadolinium enhancement and parametric mapping
Did not perform a complete CMR including late gadolinium enhancement and parametric mapping methods

Implication

CMR may support AVA assessment when TTE is limited in severe AS; leaves open clinical utility of strain correlations pending prospective validation.

Abstract

Background: Transthoracic echocardiography (TTE) is the recommended imaging technique for the evaluation of patients with aortic stenosis (AS). However, in cases with inconclusive findings, cardiac magnetic resonance (CMR) planimetry is used to grade AS severity. This study aimed to compare the results derived from TTE and CMR in patients with severe AS with normal left ventricular (LV) function. Methods: test, intraclass correlation coefficient (ICC), and Pearson correlation. P<0.05 was considered statistically significant. Results: An excellent agreement was found in AVA values derived from CMR and TTE with an average ICC of 0.932 (95% CI=0.829-0.973). There was a significant difference in LV-GLS, LV global radial strain (GRS), right ventricular (RV) GRS, and RV global circumferential strain between the groups. A good correlation was found between CMR- and TTE-derived GLS with an average ICC of 0.721 (95% C=0.255-0.896). The mean aortic valve pressure gradient in TTE had a significant inverse linear correlation with LV-GRS in CMR (r=-0.537). All P values were <0.05. Conclusion: There was a good agreement between AVA and strain values derived from cardiac MRI and TTE. The myocardial strain was impaired in patients with severe AS and normal LV function and correlated with disease severity.

Discussion

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Cite This Study

Rezaeian et al. (2023) conducted an observational in Severe aortic stenosis with normal left ventricular function (n=48). Cardiac magnetic resonance (CMR) vs. Transthoracic echocardiography (TTE) was evaluated on Agreement between aortic valve area (AVA) values derived from CMR planimetry and TTE (ICC 0.932, 95% CI 0.829-0.973, p=<0.001). Cardiac magnetic resonance demonstrated excellent agreement with transthoracic echocardiography for evaluating aortic valve area (ICC 0.932) and detecting subclinical myocardial strain impairment.

synapsesocial.com/papers/6a208e7ef14cd0624eb41b2b https://doi.org/10.30476/ijms.2022.94552.2590

Topics

Echocardiography

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Aortic Valve Area and Strain Measurements by Cardiac MRI and Transthoracic Echocardiography in Severe Aortic Stenosis with Normal Left Ventricular Function.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Aortic Valve Area and Strain Measurements by Cardiac MRI and Transthoracic Echocardiography in Severe Aortic Stenosis with Normal Left Ventricular Function.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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