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J Am Coll Cardiol, 2003; 42:519-526, doi:10.1016/S0735-1097(03)00707-1 © 2003 by the American College of Cardiology Foundation |
,*
* 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 AVAmax was 0.91 ± 0.25 cm2; by TEE, AVAmax 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 AVAmax 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.
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