Abstract
BackgroundAortic valve area (AVA) estimation in patients with aortic stenosis may be obtained using several methods. This study was undertaken to verify the cardiovascular magnetic resonance (CMR) planimetry of aortic stenosis by comparing the findings with invasive catheterization, transthoracic (TTE) as well as tranesophageal echocardiography (TEE) and anatomic CMR examination of autopsy specimens.MethodsOur study was performed in eight patients with aortic valve stenosis. Aortic stenosis was determined by TTE and TEE as well as catheterization and CMR. Especially, after aortic valve replacement, the explanted aortic valves were examined again with CMR ex vivo model.ResultsThe mean AVA determined in vivo by CMR was 0.75 ± 0.09 cm2 and ex vivo by CMR was 0.65 ± 0.09 cm2 and was closely correlated (r = 0.91, p < 0.001). The mean absolute difference between AVA derived by CMR ex vivo and in vivo was −0.10 ± 0.04 cm2. The mean AVA using TTE was 0.69 ± 0.07 with a significant correlation between CMR ex vivo (r = 0.85, p < 0.007) and CMR in vivo (r = 0.86, p < 0.008). CMR ex vivo and in vivo had no significant correlation with AVA using Gorlin formula by invasive catheterization or using planimetry by TEE.ConclusionIn this small study using an ex vivo aortic valve stenosis model, the aortic valve area can be reliably planimetered by CMR in vivo and ex vivo with a well correlation between geometric AVA by CMR and the effective AVA calculated by TTE.
Highlights
Aortic valve area (AVA) estimation in patients with aortic stenosis may be obtained using several methods
The mean absolute difference between AVA derived by cardiovascular magnetic resonance (CMR) ex vivo and calculated using the Gorlin formula by catheterization was +0.07 ± 0.26 cm2 (p = 0.498)
The mean absolute difference between AVA derived by CMR in vivo and calculated using the Gorlin formula by catheterization was +0.17 ± 0.27 cm2 (p = 0.117)
Summary
Aortic valve area (AVA) estimation in patients with aortic stenosis may be obtained using several methods. This study was undertaken to verify the cardiovascular magnetic resonance (CMR) planimetry of aortic stenosis by comparing the findings with invasive catheterization, transthoracic (TTE) as well as tranesophageal echocardiography (TEE) and anatomic CMR examination of autopsy specimens. Exact determination of the severity of stenosis is essential to guide therapy [2]. Standard methods, such as cardiac catheterization and transthoracic echocardiography (TTE) have to calculate the effective orifice area by measurement of the transvalvular pressure gradient [3, 4], as they do not allow a direct and precise measurement of the geometric orifice area. Cardiovascular magnetic resonance (CMR) is a noninvasive method that allows visualization of cardiac function, structure and valves [5, 6]. We and others have reported the success of planimetry by CMR in aortic valve [7,8,9,10,11,12,13,14]
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