Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study
By Cesare Mantini et al
Taken directly from Frontiers in Cardiovascular Medicine
Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error.
Mantini et al tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOAcmr), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. They showed that aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. However, larger studies are warranted to confirm and validate these promising preliminary results.
Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. Analysis was performed of agreement and correlation among:
- Geometric orifice area (GOAcmr) by direct CMR planimetry
- EOAecho by TTE-continuity equation
- The “gold standard” multimodality EOA (EOAhybrid) obtained by substituting CMR LVOT area into Doppler continuity equation.
There was excellent pairwise positive linear correlation among AOAcmr, EOAhybrid, GOAcmr, and EOAecho (p < 0.001); AOAcmr had the highest correlation with EOAhybrid (R2 = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOAcmr and EOAhybrid. AOAcmr yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively).
Mantini C, Khanji MY, D’Ugo E, Olivieri M, Caputi CG , Bufano G. Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study. Front. Cardiovasc. Med. October 2021. https://doi.org/10.3389/fcvm.2021.752340