Key result
4D flow CMR derived peak pressure gradient was comparable to the invasive reference standard (54 ± 26 mmHg vs 50 ± 34 mmHg, p = 0.67), whereas Doppler echocardiography significantly overestimated the gradient.
Why the study?
Management of aortic stenosis crucially depends on accurate diagnosis, motivating validation of four-dimensional flow CMR methods for aortic stenosis assessment.
Does four-dimensional flow cardiovascular magnetic resonance accurately assess pressure gradients compared to invasive assessment and echocardiography in patients with severe aortic stenosis?
Observational (n=18)
No
Does four-dimensional flow cardiovascular magnetic resonance accurately assess pressure gradients compared to invasive assessment and echocardiography in patients with severe aortic stenosis?
Absolute Event Rate: 54% vs 50%
p-value: p=0.67
4D flow CMR provides an accurate, non-invasive alternative for assessing aortic stenosis severity that correlates better with functional capacity and LV mass regression than standard echocardiography.
4D flow CMR may avoid Doppler overestimation of gradients in aortic stenosis; leaves open prospective outcome validation before practice change.
The management of patients with aortic stenosis (AS) crucially depends on accurate diagnosis. The main aim of this study were to validate the four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) methods for AS assessment. Eighteen patients with clinically severe AS were recruited. All patients had pre-valve intervention 6MWT, echocardiography and CMR with 4D flow. Of these, ten patients had a surgical valve replacement, and eight patients had successful transcatheter aortic valve implantation (TAVI). TAVI patients had invasive pressure gradient assessments. A repeat assessment was performed at 3-4 months to assess the remodelling response. The peak pressure gradient by 4D flow was comparable to an invasive pressure gradient (54 ± 26 mmHG vs 50 ± 34 mmHg, P = 0.67). However, Doppler yielded significantly higher pressure gradient compared to invasive assessment (61 ± 32 mmHG vs 50 ± 34 mmHg, P = 0.0002). 6MWT was associated with 4D flow CMR derived pressure gradient (r = -0.45, P = 0.01) and EOA (r = 0.54, P < 0.01) but only with Doppler EOA (r = 0.45, P = 0.01). Left ventricular mass regression was better associated with 4D flow derived pressure gradient change (r = 0.64, P = 0.04). 4D flow CMR offers an alternative method for non-invasive assessment of AS. In addition, 4D flow derived valve metrics have a superior association to prognostically relevant 6MWT and LV mass regression than echocardiography.
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Archer et al. (2020) conducted an observational in Aortic stenosis (n=18). Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) vs. Invasive pressure gradient assessment and Doppler echocardiography was evaluated on Peak pressure gradient (p=0.67). 4D flow CMR derived peak pressure gradient was comparable to the invasive reference standard (54 ± 26 mmHg vs 50 ± 34 mmHg, p = 0.67), whereas Doppler echocardiography significantly overestimated the gradient.
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