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

• Published in: Scientific reports Vol. 10; no. 1; p. 10569
• Main Authors: Archer, Gareth T., Elhawaz, Alaa, Barker, Natasha, Fidock, Benjamin, Rothman, Alexander, van der Geest, R. J., Hose, Rod, Briffa, Norman, Hall, Ian R., Grech, Ever, Bissell, Malenka, Al-Mohammad, Abdallah, Treibel, Thomas A., Swift, Andrew J., Wild, James M., Garg, Pankaj
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 29-06-2020; Nature Publishing Group
• Subjects: 631/1647/245/1628; 692/4019/592/75/593/1301; Aged; Aged, 80 and over; Aortic stenosis; Aortic valve; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Approximation; Cardiovascular disease; Cardiovascular System - physiopathology; Coronary vessels; Echocardiography; Echocardiography - methods; Echocardiography, Doppler - methods; Female; Four-Dimensional Computed Tomography; Heart; Heart Valve Prosthesis Implantation - methods; Humanities and Social Sciences; Humans; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging, Cine - methods; Male; Methods; multidisciplinary; Predictive Value of Tests; Pressure; Prospective Studies; Science; Science (multidisciplinary); Stenosis; Stroke Volume - physiology; Teaching hospitals; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome; Velocity; Ventricle; Ventricular Function, Left - physiology
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-66659-6

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.