Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2011 | Research

Comparison between cardiovascular magnetic resonance and transthoracic doppler echocardiography for the estimation of effective orifice area in aortic stenosis

Authors: Julio Garcia, Lyes Kadem, Eric Larose, Marie-Annick Clavel, Philippe Pibarot

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2011

Abstract

Background

The effective orifice area (EOA) estimated by transthoracic Doppler echocardiography (TTE) via the continuity equation is commonly used to determine the severity of aortic stenosis (AS). However, there are often discrepancies between TTE-derived EOA and invasive indices of stenosis, thus raising uncertainty about actual definite severity. Cardiovascular magnetic resonance (CMR) has emerged as an alternative method for non-invasive estimation of valve EOA. The objective of this study was to assess the concordance between TTE and CMR for the estimation of valve EOA.

Methods and results

31 patients with mild to severe AS (EOA range: 0.72 to 1.73 cm²) and seven (7) healthy control subjects with normal transvalvular flow rate underwent TTE and velocity-encoded CMR. Valve EOA was calculated by the continuity equation. CMR revealed that the left ventricular outflow tract (LVOT) cross-section is typically oval and not circular. As a consequence, TTE underestimated the LVOT cross-sectional area (A_LVOT, 3.84 ± 0.80 cm²) compared to CMR (4.78 ± 1.05 cm²). On the other hand, TTE overestimated the LVOT velocity-time integral (VTI_LVOT: 21 ± 4 vs. 15 ± 4 cm). Good concordance was observed between TTE and CMR for estimation of aortic jet VTI (61 ± 22 vs. 57 ± 20 cm). Overall, there was a good correlation and concordance between TTE-derived and CMR-derived EOAs (1.53 ± 0.67 vs. 1.59 ± 0.73 cm², r = 0.92, bias = 0.06 ± 0.29 cm²). The intra- and inter- observer variability of TTE-derived EOA was 5 ± 5% and 9 ± 5%, respectively, compared to 2 ± 1% and 7 ± 5% for CMR-derived EOA.

Conclusion

Underestimation of A_LVOT by TTE is compensated by overestimation of VTI_LVOT, thereby resulting in a good concordance between TTE and CMR for estimation of aortic valve EOA. CMR was associated with less intra- and inter- observer measurement variability compared to TTE. CMR provides a non-invasive and reliable alternative to Doppler-echocardiography for the quantification of AS severity.

Available only for authorised users

Bonow RO, Carabello BA, Kanu C, et al: ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006, 114: e84-e231. 10.1161/CIRCULATIONAHA.106.176857.CrossRefPubMed

Vahanian A, Baumgartner H, Bax J, et al: Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007, 28 (2): 230-68.PubMed

Hachicha Z, Dumesnil JG, Bogaty P, et al: Paradoxical low flow, low gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007, 115: 2856-2864. 10.1161/CIRCULATIONAHA.106.668681.CrossRefPubMed

Omran H, Schmidt H, Hackenbroch M, et al: Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet. 2003, 361 (9365): 1241-6. 10.1016/S0140-6736(03)12978-9.CrossRefPubMed

Cawley PJ, Maki JH, Otto CM: Cardiovascular Magnetic Resonance Imaging for Valvular Heart Disease: Technique and Validation. Circulation. 2009, 119: 468-478. 10.1161/CIRCULATIONAHA.107.742486.CrossRefPubMed

Caruthers SD, Lin SJ, Brown P, et al: Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography. Circulation. 2003, 108: 2236-2243. 10.1161/01.CIR.0000095268.47282.A1.CrossRefPubMed

Yap SC, van Geuns RJ, Meijboom FJ, et al: A simplified continuity equation approach to the quantification of stenotic bicuspid aortic valves using velocity-encoded cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2007, 9: 899-906. 10.1080/10976640701693717.CrossRefPubMed

Waters EA, Caruthers SD, Wickline SA: Correlation Analysis of Stenotic Aortic Valve Flow Patterns Using Phase Contrast MRI. Annals of Biomed Eng. 2005, 33: 878-887. 10.1007/s10439-005-2865-9.CrossRef

Hagui D, Suselbeck T, Fluechter S, et al: A hybrid approach for quantification of aortic valve stenosis using cardiac magnetic resonance imaging and echocardiography: comparison to right heart catheterization and standard echocardiography. Clin Res Cardiol. 2006, 95: 162-167. 10.1007/s00392-006-0355-1.CrossRef

10.

O'Brien KR, Gabriel RS, Greiser A, et al: Aortic valve stenotic area calculation from phase contrast cardiovascular magnetic resonance: the importance of short echo time. J Cardiovasc Magn Reson. 2009, 11: 49-10.1186/1532-429X-11-49.PubMedCentralCrossRefPubMed

11.

Malyar NM, Schlosser T, Barkhausen J, et al: Assessment of Aortic Valve Area in Aortic Stenosis Using Cardiac Magnetic Resonance Tomography: Comparison with Echocardiography. Cardiology. 2008, 109: 126-134. 10.1159/000105554.CrossRefPubMed

12.

Ropers D, Ropers U, Marwan M, et al: Comparison of dual-source computed tomography for the quantification of the aortic valve area in patients with aortic stenosis versus transthoracic echocardiography and invasive hemodynamic assessment. Am J Cardiol. 2009, 104 (11): 1561-7. 10.1016/j.amjcard.2009.07.024.CrossRefPubMed

13.

Bruder O, Jochims M, Hunold P, et al: Comparison of Aortic Valve Area Measured by Magnetic Resonance Imaging and Dual-Source Computed Tomography. Acta Radiol. 2009, 50 (6): 645-51. 10.1080/02841850902902540.CrossRefPubMed

14.

Garcia D, Kadem L: What do you mean by aortic valve area: geometric orifice area, effective orifice area, or gorlin area?. J Heart Valve Dis. 2006, 15 (5): 601-8.PubMed

15.

Pibarot P, Larose E: What our eyes see is not necessarily what our heart feels. Cardiology. 2008, 109 (2): 122-5. 10.1159/000105553.CrossRefPubMed

16.

Quinones MA, Otto CM, Stoddard M, et al: Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of E: Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002, 15: 167-184. 10.1067/mje.2002.120202.CrossRefPubMed

17.

Garcia J, Kadem L, Larose E, Pibarot P: In vivo Velocity and Flow Errors Quantification by Phase-Contrast Magnetic Resonance Imaging. Conf Proc IEEE Eng Med Biol Soc. 2008, 2008: 1377-1380.PubMed

18.

Pibarot P, Dumesnil JG: Assessment of aortic stenosis severity: when the gradient does not fit with the valve area. Heart. 2010, 96: 1431-1433. 10.1136/hrt.2010.195149.CrossRefPubMed

19.

Dumesnil JG, Pibarot P, Akins C: New Approches to Quantifying Aortic Stenosis Severity. Current Cardiology Reports. 2008, 10: 91-97. 10.1007/s11886-008-0017-1.CrossRefPubMed

20.

Johnson MA, Moss RR, Munt B: Determining Aortic Stenosis Severity: What to Do When Measuring Left Ventricular Outflow Tract Diameter Is Difficult. J Am Soc Echocardiogr. 2009, 22: 452-453. 10.1016/j.echo.2009.03.018.CrossRefPubMed

21.

Stolzmann P, Knight J, Desbiolles L, et al: Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for trascatheter aoritc valve implantation. Eur Radiol. 2009, 19: 1316-1323. 10.1007/s00330-009-1302-0.CrossRefPubMed

22.

Leye M, Brochet E, Lepage L, et al: Size-adjusted left ventricular outflow tract diameter reference values: a safeguard for the evaluation of the severity of aortic stenosis. J Am Soc Echocardiogr. 2009, 22: 445-451. 10.1016/j.echo.2009.02.007.CrossRefPubMed

23.

Baumgartner H, Kratzer H, Helmreich G, et al: Determination of aortic valve area by Doppler echocardiography using the continuity equation: a critical evaluation. Cardiology. 1990, 77: 101-111. 10.1159/000174590.CrossRefPubMed

24.

Halpern EJ, Mallya R, Sewell M, et al: Differences in aortic valve area measured with CT planimetry and echocardiography (continuity equation) are related to divergent estimates of left ventricular outflow tract area. AJR Am Roentgenol. 2009, 192: 1668-1673. 10.2214/AJR.08.1986.CrossRef

25.

Schoenhagen P, Tuzcu EM, Kapadia SR, et al: Three-dimensional imaging of the aortic valve and aortic root with computed tomography: new standards in an era of transcatheter valve repair/implantation. Eur Heart J. 2009, 30: 2079-2086. 10.1093/eurheartj/ehp260.CrossRefPubMed

26.

Doddamani S, Grushko MJ, Makaryus AN: Demonstration of left ventricular outflow tract eccentricity by 64-slice multi-detector CT. Int J Cardiovasc Imaging. 2009, 25: 175-181. 10.1007/s10554-008-9362-9.CrossRefPubMed

27.

Gilon D, Cape GC, Handschumacher MD, Song JK, et al: Effect of Three-Dimensional Valve Shape on the Hemodynamics of Aortic Stenosis: Three-Dimensional Echocardiographic Stereolithography and Patient Studies. J Am Coll Cardiol. 2002, 40: 1479-86. 10.1016/S0735-1097(02)02269-6.CrossRefPubMed

28.

Minners J, Allgeier M, Gohlke-Baerwolf C, et al: Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis. Eur Heart J. 2008, 29 (8): 1043-8. 10.1093/eurheartj/ehm543.CrossRefPubMed

29.

Dumesnil JG, Pibarot P, Carabello B: Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatement. Eur Heart J. 2010, 31: 281-289. 10.1093/eurheartj/ehp361.PubMedCentralCrossRefPubMed

30.

Chambers J, Bach D, Dumesnil JG, et al: Crossing the Aortic Valve in Severe Aortic Stenosis: No Longer Acceptable?. J Heart Valve Dis. 2004, 12 (5): 344-6.

Title: Comparison between cardiovascular magnetic resonance and transthoracic doppler echocardiography for the estimation of effective orifice area in aortic stenosis
Authors: Julio Garcia
Lyes Kadem
Eric Larose
Marie-Annick Clavel
Philippe Pibarot
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2011
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/1532-429X-13-25

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison between cardiovascular magnetic resonance and transthoracic doppler echocardiography for the estimation of effective orifice area in aortic stenosis

Abstract

Background

Methods and results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2011

Effects of steroids and angiotensin converting enzyme inhibition on circumferential strain in boys with Duchenne muscular dystrophy: a cross-sectional and longitudinal study utilizing cardiovascular magnetic resonance

Prevalence and prognosis of myocardial scar in patients with known or suspected coronary artery disease and normal wall motion

Comparison of long and short axis quantification of left ventricular volume parameters by cardiovascular magnetic resonance, with ex-vivo validation

Value of black blood T2* cardiovascular magnetic resonance

3D Echo systematically underestimates right ventricular volumes compared to cardiovascular magnetic resonance in adult congenital heart disease patients with moderate or severe RV dilatation

The relative atrial volume ratio and late gadolinium enhancement provide additive information to differentiate constrictive pericarditis from restrictive cardiomyopathy