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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

View larger version (236K): [in a new window]   Figure 1 Slice positioning for planimetry of the aortic valve. (A) Oblique transaxial view of the aortic outflow tract, with the magnetic resonance (MR) slice position indicated by two white lines. (B) Oblique sagittal view of the aortic outflow tract, with the MR slice position indicated by two white lines orthogonal to the stenotic jet. Continued on next page. (C) Cross-sectional view of a moderately stenotic aortic valve; the gray line denotes the aortic valve area (AVA). (D) Cross-sectional view of a severely stenotic aortic valve; the white line denotes the AVA. Ao = ascending aorta; LV = left ventricle.

View larger version (19K): [in a new window]   Figure 2 (A) Linear regression between MR-derived and transesophageal echocardiography (TEE)-derived aortic valve areas (AVAs). There is a good correlation between AVA by magnetic resonance (MR) and that by TEE, as indicated by the proximity of data points. Solid diamonds = actual AVA by MR; open circles = predicted AVA by MR. (B) Linear regression plot between Doppler- and catheter-derived pressure gradients. The data points are less close; however, there is still a good correlation, although less than that between MR and TEE AVAs. Solid diamonds = pressure gradient (DP) by cardiac catheterization (cath); open circles = predicted pressure gradient by cardiac catheterization.

View larger version (17K): [in a new window]   Figure 3 (A) Bland-Altman plot of magnetic resonance-derived versus transesophageal echocardiography-derived aortic valve area, showing no difference in the variability depending on the magnitude of the measurement and no significant bias. (B) Bland-Altman plot of the Doppler gradient versus catheter gradient, showing no significant bias between Doppler- and catheter-derived pressure gradients. Variability between the two is independent of the magnitude of the data. SD = standard deviation.