Validation of four-dimensional flow cardiovascular magnetic resonance for aortic stenosis assessment

Sci Rep. 2020 Jun 29;10(1):10569. doi: 10.1038/s41598-020-66659-6.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery
  • Aortic Valve Stenosis / diagnostic imaging*
  • Aortic Valve Stenosis / surgery
  • Cardiovascular System / physiopathology
  • Echocardiography / methods
  • Echocardiography, Doppler / methods
  • Female
  • Four-Dimensional Computed Tomography
  • Heart Valve Prosthesis Implantation / methods
  • Humans
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Imaging, Cine / methods*
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Stroke Volume / physiology
  • Transcatheter Aortic Valve Replacement / methods
  • Treatment Outcome
  • Ventricular Function, Left / physiology