TY - JOUR
T1 - Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis
AU - Grafton-Clarke, Ciaran
AU - Assadi, Hosamadin
AU - Li, Rui
AU - Mehmood, Zia
AU - Hall, Rimma
AU - Matthews, Gareth
AU - Tsampasian, Vasiliki
AU - Alabed, Samer
AU - Kasmai, Bahman
AU - Staff, Laura
AU - Curtin, John
AU - Yashoda, Gurung-Koney
AU - Sun, Julia
AU - Nair, Sunil
AU - Hewson, David
AU - Thampi, Kurian
AU - Broncano, Jordi
AU - Ricci, Fabrizio
AU - Swoboda, Peter
AU - Swift, Andrew J.
AU - Vassiliou, Vassilios S.
AU - van der Geest, Rob J.
AU - Garg, Pankaj
N1 - Data availability statement Data are available upon reasonable request. The data sets generated and analysed during the current study are not publicly available. Access to the raw images of patients is not permitted since specialised postprocessing imaging-based solutions can identify the study patients in the future. Data are available from the corresponding author upon reasonable request.
Funding information: PG and AJS are funded by Wellcome Trust Clinical Research Career Development Fellowships (220703/Z/20/Z and 205188/Z/16/Z). For the purpose of Open Access, the authors have applied a CC BY public copyright licence to any author accepted manuscript version arising from this submission. The funders had no role in study design, data collection, analysis, publishing decision or manuscript preparation.
PY - 2025/5/7
Y1 - 2025/5/7
N2 - Aims Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (V Peak), grading AS severity and predicting AV intervention in a real-world setting. Methods Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included. AS severity was graded using established protocols using three echocardiographic parameters (V Peak, AV area and mean pressure gradient) and CMR-derived V Peak. Results The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V Peak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V Peak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V Peak by CWD was significantly lower to 4D flow with a bias of -0.5 (p=0.01) and a correlation of (R=0.55, p=0.002). The Cox-regression analysis reveals that 4D flow V Peak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V Peak (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ2=9.5, p=0.02). Conclusion 4D flow CMR-derived V Peak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.
AB - Aims Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (V Peak), grading AS severity and predicting AV intervention in a real-world setting. Methods Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included. AS severity was graded using established protocols using three echocardiographic parameters (V Peak, AV area and mean pressure gradient) and CMR-derived V Peak. Results The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V Peak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V Peak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V Peak by CWD was significantly lower to 4D flow with a bias of -0.5 (p=0.01) and a correlation of (R=0.55, p=0.002). The Cox-regression analysis reveals that 4D flow V Peak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V Peak (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ2=9.5, p=0.02). Conclusion 4D flow CMR-derived V Peak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.
KW - Aortic Valve Stenosis
KW - Echocardiography
KW - Magnetic Resonance Imaging
UR - http://www.scopus.com/inward/record.url?scp=105004704847&partnerID=8YFLogxK
U2 - 10.1136/openhrt-2024-003081
DO - 10.1136/openhrt-2024-003081
M3 - Article
AN - SCOPUS:105004704847
SN - 2398-595X
VL - 12
JO - Open Heart
JF - Open Heart
IS - 1
M1 - e003081
ER -