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Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity : A Prospective Pilot Study

Mantini, Cesare ; Khanji, Mohammed Y. ; D’ugo, Emilia ; Olivieri, Marzia ; Caputi, Cristiano Giovanni ; Bufano, Gabriella ; Mastrodicasa, Domenico ; Garcia, Darien Calvo ; Rotondo, Domenico and Candeloro, Matteo , et al. (2021) In Frontiers in Cardiovascular Medicine 8.
Abstract

Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOAcmr ), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age-and sex-matched healthy controls had TTE and CMR examinations on the same day. We... (More)

Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOAcmr ), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age-and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOAcmr; (ii) geometric orifice area (GOAcmr ) by direct CMR planimetry; (iii) EOAecho by TTE-continuity equation; and (iv) the “gold standard” multimodality EOA (EOAhybrid ) obtained by substituting CMR LVOT area into Doppler continuity equation. Results: There was excellent pairwise positive linear correlation among AOAcmr, EOAhybrid, GOAcmr, and EOAecho (p < 0.001); AOAcmr had the highest correlation with EOAhybrid (R2 = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOAcmr and EOAhybrid . AOAcmr yielded excellent intra-and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Aliasing analysis, Aortic stenosis (AS), CMR, Echocardiography, Phase contrast (PC), Valvular heart disease
in
Frontiers in Cardiovascular Medicine
volume
8
article number
752340
publisher
Frontiers Media S. A.
external identifiers
  • scopus:85123873135
  • pmid:34733896
ISSN
2297-055X
DOI
10.3389/fcvm.2021.752340
language
English
LU publication?
yes
id
5ef032f6-58b0-47ae-937b-ccef2989c6b4
date added to LUP
2022-04-12 16:53:30
date last changed
2024-06-18 03:19:35
@article{5ef032f6-58b0-47ae-937b-ccef2989c6b4,
  abstract     = {{<p>Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOA<sub>cmr</sub> ), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age-and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOA<sub>cmr</sub>; (ii) geometric orifice area (GOA<sub>cmr</sub> ) by direct CMR planimetry; (iii) EOA<sub>echo</sub> by TTE-continuity equation; and (iv) the “gold standard” multimodality EOA (EOA<sub>hybrid</sub> ) obtained by substituting CMR LVOT area into Doppler continuity equation. Results: There was excellent pairwise positive linear correlation among AOA<sub>cmr</sub>, EOA<sub>hybrid</sub>, GOA<sub>cmr</sub>, and EOA<sub>echo</sub> (p &lt; 0.001); AOA<sub>cmr</sub> had the highest correlation with EOA<sub>hybrid</sub> (R<sup>2</sup> = 0.985, p &lt; 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOA<sub>cmr</sub> and EOA<sub>hybrid</sub> . AOA<sub>cmr</sub> yielded excellent intra-and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.</p>}},
  author       = {{Mantini, Cesare and Khanji, Mohammed Y. and D’ugo, Emilia and Olivieri, Marzia and Caputi, Cristiano Giovanni and Bufano, Gabriella and Mastrodicasa, Domenico and Garcia, Darien Calvo and Rotondo, Domenico and Candeloro, Matteo and Tana, Claudio and Cademartiri, Filippo and Ionescu, Adrian and Caulo, Massimo and Gallina, Sabina and Ricci, Fabrizio}},
  issn         = {{2297-055X}},
  keywords     = {{Aliasing analysis; Aortic stenosis (AS); CMR; Echocardiography; Phase contrast (PC); Valvular heart disease}},
  language     = {{eng}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Cardiovascular Medicine}},
  title        = {{Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity : A Prospective Pilot Study}},
  url          = {{http://dx.doi.org/10.3389/fcvm.2021.752340}},
  doi          = {{10.3389/fcvm.2021.752340}},
  volume       = {{8}},
  year         = {{2021}},
}