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Evaluation of Aortic Valve Stenosis using Cardiovascular Magnetic Resonance: Comparison of an Original Semi-Automated Analysis of Phase-Contrast-CMR with Doppler Echocardiography.
MedLine Citation:
PMID:  22798520     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Accurate quantification of aortic valve stenosis (AVS) is needed for relevant management decisions. However, transthoracic Doppler-echocardiography (TTE) remains inconclusive in a significant number of patients. Previous studies demonstrated the usefulness of phase-contrast cardiovascular magnetic resonance (PC-CMR) in noninvasive AVS evaluation. We hypothesized that semi-automated analysis of aortic hemodynamics from PC-CMR might provide reproducible and accurate evaluation of aortic valve area (AVA), aortic velocities and gradients in agreement with TTE. METHODS AND RESULTS: -We studied 53 AVS patients (AVA(TTE)=0.87±0.44cm(2)) and 21 controls (AVA(TTE)=2.96±0.59cm(2)) who had TTE and PC-CMR of aortic valve and left ventricular outflow tract (LVOT) on the same day. PC-CMR data analysis included LVOT and aortic valve segmentation, and extraction of velocities, gradients and flow-rates. Three AVA measures were performed: AVA(CMR1) based on Hakki's formula, AVA(CMR2) based on continuity equation, AVA(CMR3) simplified continuity equation=LVOT peak flow-rate/aortic peak velocity. Our analysis was reproducible, as reflected by low inter-operator variability (<4.56±4.40%). Comparison of PC-CMR and TTE aortic peak velocities and mean gradients resulted in good agreement (r=0.92 with mean bias=-29±62cm/s and r=0.86 with mean bias=-12±15mmHg , respectively). While good agreement was found between TTE and continuity equation-based CMR-AVA (r>0.94 and mean bias= 0.01±0.38cm(2) for AVA(CMR2), -0.09±0.28cm(2) for AVA(CMR3)), AVA(CMR1) values were lower than AVA(TTE) especially for higher AVA (mean bias=-0.45±0.52cm(2)). Besides, ability of PC-CMR to detect severe AVS, defined by TTE, provided the best results for continuity equation-based methods (accuracy>94%). CONCLUSIONS: -Our PC-CMR semi-automated AVS evaluation provided reproducible measurements that accurately detected severe AVS and were in good agreement with TTE.
Authors:
Carine Defrance; Emilie Bollache; Nadjia Kachenoura; Ludivine Perdrix; Nataliya Hrynchyshyn; Eric Bruguière; Alban Redheuil; Benoit Diebold; Elie Mousseaux
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-13
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  -     ISSN:  1942-0080     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 INSERM U678/UPMC Univ Paris 6 and European Hospital Georges Pompidou, APHP, Paris, France;
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