Key result
Semi-automated 4D flow CMR correlates well with invasive catheterization for assessing peak AVPG.
Why the study?
While 4D flow CMR is valuable for estimating peak pressure drop across the aortic valve, assessment remains cumbersome, warranting validation of a novel semi-automated pipeline method against invasive catheterisation.
Does a semi-automated 4D flow CMR pipeline accurately quantify peak aortic valve pressure gradient compared to invasive cardiac catheterization in patients with severe aortic stenosis?
Observational (n=11)
Single-blind
Yes
Does a semi-automated 4D flow CMR pipeline accurately quantify peak aortic valve pressure gradient compared to invasive cardiac catheterization in patients with severe aortic stenosis?
Effect estimate: r = 0.70
Absolute Event Rate: 52.2% vs 51.9%
p-value: p=0.017
A novel semi-automated 4D flow CMR pipeline provides accurate assessment of peak aortic valve pressure gradients that correlates well with invasive catheterization in patients with severe aortic stenosis.
May support non-invasive gradient assessment in severe AS; leaves open prospective validation before clinical adoption.
OBJECTIVE: Doppler echocardiographic aortic valve peak velocity and peak pressure gradient assessment across the aortic valve (AV) is the mainstay for diagnosing aortic stenosis. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is emerging as a valuable diagnostic tool for estimating the peak pressure drop across the aortic valve, but assessment remains cumbersome. We aimed to validate a novel semi-automated pipeline 4D flow CMR method of assessing peak aortic value pressure gradient (AVPG) using the commercially available software solution, CAAS MR Solutions, against invasive angiographic methods. RESULTS: We enrolled 11 patients with severe AS on echocardiography from the EurValve programme. All patients had pre-intervention doppler echocardiography, invasive cardiac catheterisation with peak pressure drop assessment across the AV and 4D flow CMR. The peak AVPG was 51.9 ± 35.2 mmHg using the invasive pressure drop method and 52.2 ± 29.2 mmHg for the 4D flow CMR method (semi-automated pipeline), with good correlation between the two methods (r = 0.70, p = 0.017). Assessment of AVPG by 4D flow CMR using the novel semi-automated pipeline method shows excellent agreement to invasive assessment when compared to doppler-based methods and advocate for its use as complementary to echocardiography.
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Grafton‐Clarke et al. (2022) conducted an observational in Severe aortic stenosis (n=11). Semi-automated 4D flow CMR pipeline vs. Invasive cardiac catheterization was evaluated on Peak aortic valve pressure gradient (AVPG) (r = 0.70, p=0.017). Assessment of peak aortic valve pressure gradient using a novel semi-automated 4D flow CMR pipeline showed good correlation (r = 0.70, p = 0.017) and minimal bias compared to invasive cardiac catheterization.
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