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CLINICAL STUDY

Magnetic resonance to assess the aortic valve area in aortic stenosis

How does it compare to current diagnostic standards?

Anna S. John, MD^*,*, Thorsten Dill, MD^*, Roland R. Brandt, MD, FACC^*, Matthias Rau, MD^*, Wolfgang Ricken, MD^*, Georg Bachmann, MD and Christian W. Hamm, MD, FACC^*

^* Departments of Cardiology, Kerckhoff Clinic, Bad Nauheim, Germany
Radiology, Kerckhoff Clinic, Bad Nauheim, Germany
CMR Unit, Royal Brompton Hospital, London, United Kingdom

Manuscript received May 13, 2002; revised manuscript received April 9, 2003, accepted April 24, 2003.

^* Reprint requests and correspondence: Dr. Anna S. John, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
a.john{at}rbh.nthames.nhs.uk

OBJECTIVES: The purpose of the present study was to evaluate whether magnetic resonance (MR) planimetry of the aortic valve area (AVA) may prove to be a reliable, non-invasive diagnostic tool in the assessment of aortic valve stenosis, and how the results compare with current diagnostic standards.

BACKGROUND: Current standard techniques for assessing the severity of aortic stenosis include transthoracic and transesophageal echocardiography (TEE) as well as transvalvular pressure measurements during cardiac catheterization.

METHODS: Forty consecutive patients underwent cardiac catheterization, TEE, and MR. The AVA was estimated by direct planimetry (MR, TEE) or calculated indirectly via the peak systolic transvalvular gradient (catheter). Pressure gradients from cardiac catheterization and Doppler echocardiography were also compared.

RESULTS: By MR, the mean AVA_max was 0.91 ± 0.25 cm²; by TEE, AVA_max was 0.89 ± 0.28 cm²; and by catheter, the AVA was calculated as 0.64 ± 0.26 cm². Mean absolute differences in AVA were 0.02 cm² for MR versus TEE, 0.27 cm² for MR versus catheter, and 0.25 cm² for TEE versus catheter. Correlations for AVA_max were r = 0.96 between MR and TEE, r = 0.47 between TEE and catheter, and r = 0.44 between MR and catheter. The correlation between Doppler and catheter gradients was r = 0.71.

CONCLUSIONS: Magnetic resonance planimetry of the AVA correlates well with TEE and less well with the catheter-derived AVA. Invasive and Doppler pressure correlated less well than those obtained from planimetric techniques. Magnetic resonance planimetry of the AVA may provide an accurate, non-invasive, well-tolerated alternative to invasive techniques and transthoracic echocardiography in the assessment of aortic stenosis.

Abbreviations and Acronyms   ACC/AHA   American College of Cardiology/American Heart Association   AF   atrial fibrillation   AS   aortic stenosis   TTE   transthoracic echocardiography   LV   left ventricle/ventricular   AVA   aortic valve area   MR   magnetic resonance   TEE   transesophageal echocardiography

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