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

Archer, Gareth; Elhawaz, Alaa; Barker, Natasha; Fidock, Benjamin; Rothman, Alexander; Geest, Rob J. van der; Hose, Rod; Briffa, Norman; Hall, Ian; Grech, Ever; Bissell, Malenka M.; Al‐Mohammad, Abdallah; Treibel, Thomas A.; Swift, Andrew J.; Wild, Jim M.

doi:10.1038/s41598-020-66659-6

Cited by 30 publications

(19 citation statements)

References 27 publications

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“…In the carotid arteries, peak velocities were found to be lower with 4D Flow MRI than with ultrasound [30]. Other investigators found comparable results for 4D Flow MRI to 2D-PC [31], or even higher peak velocities in stenotic lesions such as aortic stenosis in patients with transposition of the great arteries [32]. While continued work may be required to further optimize 4D Flow acquisition and more definitively compare results to invasive catheterization, we highlight a few strategies to maximize measurement technique.…”

Section: Arterial Stenosismentioning

confidence: 73%

Hemodynamic Assessment of Structural Heart Disease Using 4D Flow MRI: How We Do It

Jacobs

Hahn

Horowitz

et al. 2021

American Journal of Roentgenology

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The publication of this Accepted Manuscript is provided to give early visibility to the contents of the article, which will undergo additional copyediting, typesetting, and review before it is published in its final form. During the production process, errors may be discovered that could affect the content of the Accepted Manuscript. All legal disclaimers that apply to the journal pertain. The reader is cautioned to consult the definitive version of record before relying on the contents of this document.

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Section: Arterial Stenosismentioning

confidence: 73%

Hemodynamic Assessment of Structural Heart Disease Using 4D Flow MRI: How We Do It

Jacobs

Hahn

Horowitz

et al. 2021

American Journal of Roentgenology

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“…Finally, time-resolved 3D PC (4D-flow) was not performed. 4D flow has been shown to overcome some of the 2D PC-CMR limitations and is an extremely promising tool in this field [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of stroke volume measurement with phase-contrast cardiovascular magnetic resonance in patients with aortic stenosis

Guzzetti

Racine

Tastet

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Phase contrast (PC) cardiovascular magnetic resonance (CMR) in the ascending aorta (AAo) is widely used to calculate left ventricular (LV) stroke volume (SV). The accuracy of PC CMR may be altered by turbulent flow. Measurement of SV at another site is suggested in the presence of aortic stenosis, but very few data validates the accuracy or inaccuracy of PC in that setting. Our objective is to compare flow measurements obtained in the AAo and LV outflow tract (LVOT) in patients with aortic stenosis. Methods Retrospective analysis of patients with aortic stenosis who had CMR and echocardiography. Patients with mitral regurgitation were excluded. PC in the AAo and LVOT were acquired to derive SV. LV SV from end-systolic and end-diastolic tracings was used as the reference measure. A difference ≥ 10% between the volumetric method and PC derived SVs was considered discordant. Metrics of turbulence and jet eccentricity were assessed to explore the predictors of discordant measurements. Results We included 88 patients, 41% with bicuspid aortic valve. LVOT SV was concordant with the volumetric method in 79 (90%) patients vs 52 (59%) patients for AAo SV (p = 0.015). In multivariate analysis, aortic stenosis flow jet angle was a strong predictor of discordant measurement in the AAo (p = 0.003). Mathematical correction for the jet angle improved the concordance from 59 to 91%. Concordance was comparable in patients with bicuspid and trileaflet valves (57% and 62% concordance respectively; p = 0.11). Accuracy of SV measured in the LVOT was not influenced by jet eccentricity. For aortic regurgitation quantification, PC in the AAo had better correlation to volumetric assessments than LVOT PC. Conclusion LVOT PC SV in patients with aortic stenosis and eccentric jet might be more accurate compared to the AAo SV. Mathematical correction for the jet angle in the AAo might be another alternative to improve accuracy.

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“…Data pre-processing was done on the scanner for correcting phase offset errors such as eddy currents, Maxwell effects, and encoding errors related to gradient field distortions to avoid impairment of the measurements and inaccuracies in flow quantification (14,15).…”

Section: D Flow Correctionsmentioning

confidence: 99%

Left ventricular blood flow kinetic energy is associated with the six-minute walk test and left ventricular remodelling post valvular intervention in aortic stenosis

Elhawaz

Archer

Zafar

et al. 2021

Quant Imaging Med Surg

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Background: Left ventricular (LV) kinetic energy (KE) assessment by four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) may offer incremental value over routine assessment in aortic stenosis (AS). The main objective of this study is to investigate the LV KE in patients with AS before and after the valve intervention. In addition, this study aimed to investigate if LV KE offers incremental value for its association to the six-minute walk test (6MWT) or LV remodelling post-intervention. Methods:We recruited 18 patients with severe AS. All patients underwent transthoracic echocardiography for mean pressure gradient (mPG), CMR including 4D flow and 6MWT. Patients were invited for post-valve intervention follow-up CMR at 3 months and twelve patients returned for follow-up CMR. KE assessment of LV blood flow and the components (direct, delayed, retained and residual) were carried out for all cases.LV KE parameters were normalised to LV end-diastolic volume (LVEDV).Results: For LV blood flow KE assessment, the metrics including time delay (TD) for peak E-wave from base to mid-ventricle (14±48 vs. 2.5±9.75 ms, P=0.04), direct (4.91±5.07 vs. 1.86±1.72 μJ, P=0.01) and delayed (2.46±3.13 vs. 1.38±1.15 μJ, P=0.03) components of LV blood flow demonstrated a significant change between pre-and post-valve intervention. Only LV KEi EDV (r=−0.53, P<0.01), diastolic KEi EDV (r=−0.53, P<0.01) and E wave KEi EDV (r=−0.38, P=0.04) demonstrated association to the 6MWT. However, Pre-operative LV KEi EDV (r=0.67, P=0.02) demonstrated association to LV remodelling post valve intervention. Conclusions: LV blood flow KE is associated with 6MWT and LV remodelling in patients with AS. LV KE assessment provides incremental value over routine LV function and pressure gradient (PG) assessment in AS.

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

Cited by 30 publications

References 27 publications

Hemodynamic Assessment of Structural Heart Disease Using 4D Flow MRI: How We Do It

Hemodynamic Assessment of Structural Heart Disease Using 4D Flow MRI: How We Do It

Accuracy of stroke volume measurement with phase-contrast cardiovascular magnetic resonance in patients with aortic stenosis

Left ventricular blood flow kinetic energy is associated with the six-minute walk test and left ventricular remodelling post valvular intervention in aortic stenosis

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