Key result
Systolic non-contrast MRA showed a high correlation with systolic CTA for measuring aortic annulus area (ICC 0.891), though virtual MRA-based sizing led to device under-sizing in 21% of patients.
Why the study?
The study sought to investigate the feasibility of measuring aortic annular size using non-contrast MRA compared with CTA in consecutive patients evaluated for TAVR.
Does non-contrast MRA provide comparable aortic annulus measurements to CTA for TAVR device sizing in patients with severe aortic stenosis?
Cohort (n=68)
Blinded observers
No
Does non-contrast MRA provide comparable aortic annulus measurements to CTA for TAVR device sizing in patients with severe aortic stenosis?
Effect estimate: ICC 0.891 (95% CI 0.830-0.932)
While non-contrast systolic MRA correlates well with CTA for aortic annulus measurement in TAVR candidates, relying solely on MRA for device sizing may lead to under-sizing and an increased risk of paravalvular regurgitation.
Non-contrast systolic MRA correlates with CTA for annular sizing but risks undersizing; leaves open routine TAVR adoption pending prospective validation.
The purpose of this retrospective study is to investigate the feasibility of measurement of aortic annular size using a respiratory and non-contrast magnetic resonance angiography (MRA) in comparison to those of computed tomography angiography (CTA) in an unselected, consecutive cohort of patients evaluated for transcatheter aortic valve replacement (TAVR). Of 295 consecutive patients (mean age 83.0 ± 4.5 years) with severe aortic stenosis, 68 underwent pre-TAVR CTA and a non-contrast balanced steady-state free precession MRA at 1.5 T. This study evaluated potential discrepancies in preoperative assessments of TAVR device size selection determined by CTA and MRA, and compared with paravalvular aortic valve regurgitation (PAR). The aortic annulus area (AAA) and perimeter (AAP) measured with systolic MRA showed a higher correlation to systolic CTA than those measured with diastolic MRA: intraclass correlation coefficient (ICC) with 95% concordance index (CI) of measured AAA between systolic CTA vs. systolic and diastolic MRA, 0.891 (CI 0.830-0.932) and 0.833 (CI 0.742-0.893), respectively; ICC with 95% CI of measured AVP between systolic CTA vs. systolic and diastolic MRA, 0.892 (CI 0.831-0.932) and 0.841 (CI 0.754-0.899). Of the 68 patients, 52 assigned the same device size, 2 assigned an oversized device, and 14 assigned undersized devices when sizing was based on systolic MRA as compared to systolic CTA. Virtual MRA-sizing assigned under-sizing for 14 patients, 9 of whom presented PAR grade 1 by CTA-sizing. This under-sizing could potentially increase the severity of PAR postoperatively, with the possibility of escalating PAR to grade 2 or above.
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Sato et al. (2024) conducted a cohort in Severe aortic stenosis (n=68). Non-contrast magnetic resonance angiography (MRA) vs. Computed tomography angiography (CTA) was evaluated on Intraclass correlation coefficient of aortic annulus area between systolic MRA and systolic CTA (ICC 0.891, 95% CI 0.830-0.932). Systolic non-contrast MRA showed a high correlation with systolic CTA for measuring aortic annulus area (ICC 0.891), though virtual MRA-based sizing led to device under-sizing in 21% of patients.
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