Validation of aortic valve pressure gradient quantification using semi-automated 4D flow CMR pipeline

Ciaran Grafton-Clarke, Paul Njoku, Jean-Paul Aben, Leon Ledoux, Liang Zhong, Jos Westenberg, Andrew Swift, Gareth Archer, James Wild, Rod Hose, Marcus Flather, Vassilios S. Vassiliou, Pankaj Garg

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Objective: Doppler echocardiographic aortic valve peak velocity and peak pressure gradient assessment across the aortic valve (AV) is the mainstay for diagnosing aortic stenosis. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is emerging as a valuable diagnostic tool for estimating the peak pressure drop across the aortic valve, but assessment remains cumbersome. We aimed to validate a novel semi-automated pipeline 4D flow CMR method of assessing peak aortic value pressure gradient (AVPG) using the commercially available software solution, CAAS MR Solutions, against invasive angiographic methods. Results: We enrolled 11 patients with severe AS on echocardiography from the EurValve programme. All patients had pre-intervention doppler echocardiography, invasive cardiac catheterisation with peak pressure drop assessment across the AV and 4D flow CMR. The peak AVPG was 51.9 ± 35.2 mmHg using the invasive pressure drop method and 52.2 ± 29.2 mmHg for the 4D flow CMR method (semi-automated pipeline), with good correlation between the two methods (r = 0.70, p = 0.017). Assessment of AVPG by 4D flow CMR using the novel semi-automated pipeline method shows excellent agreement to invasive assessment when compared to doppler-based methods and advocate for its use as complementary to echocardiography.

Original languageEnglish
Article number151
JournalBMC Research Notes
Publication statusPublished - 29 Apr 2022


  • Aortic stenosis
  • Cardiac MRI
  • Validation

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