Abstract
BackgroundAs the average age of patients with severe aortic stenosis (AS) who receive procedural intervention continue to age, the need for non-invasive modalities that provide accurate diagnosis and operative planning is increasingly important. Advances in cardiovascular magnetic resonance (CMR) over the past two decades mean it is able to provide haemodynamic data at the aortic valve, along with high fidelity anatomical imaging.MethodsElectronic databases were searched for studies comparing CMR to transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) in the diagnosis of AS. Studies were included only if direct comparison was made on matched patients, and if diagnosis was primarily through measurement of aortic valve area (AVA).ResultsTwenty-three relevant, prospective articles were included in the meta-analysis, totalling 1040 individual patients. There was no significant difference in AVA measured as by CMR compared to TEE. CMR measurements of AVA size were larger compared to TTE by an average of 10.7% (absolute difference: + 0.14cm2, 95% CI 0.07–0.21, p < 0.001). Reliability was high for both inter- and intra-observer measurements (0.03cm2 +/− 0.04 and 0.02cm2 +/− 0.01, respectively).ConclusionsOur analysis demonstrates the equivalence of AVA measurements using CMR compared to those obtained using TEE. CMR demonstrated a small but significantly larger AVA than TTE. However, this can be attributed to known errors in derivation of left ventricular outflow tract size as measured by TTE. By offering additional anatomical assessment, CMR is warranted as a primary tool in the assessment and workup of patients with severe AS who are candidates for surgical or transcatheter intervention.
Highlights
Cardiovascular magnetic resonance imaging (CMR) has, since its introduction in the 1980s, evolved to become a viable non-invasive alternative to echocardiography for a Woldendorp et al Journal of Cardiovascular Magnetic Resonance (2020) 22:45 the quality of the anatomical and functional information available from cardiovascular magnetic resonance (CMR)
Diagnosis of aortic stenosis (AS), and severe AS is determined by a combination of mean and peak pressure gradients across the valve as well as the effective valve orifice, or aortic valve area (AVA) [2]
Several methods have been designed to calculate this, including the Gorlin formula [4] for use with invasive cardiac catheterisation, the continuity equation [5] used with transthoracic echocardiography (TTE) and determined on a series of measurements including the left ventricular outflow tract (LVOT), and planimetry [6] and computed tomography (CT) that determine AVA by direct measurement of the valve orifice
Summary
Cardiovascular magnetic resonance imaging (CMR) has, since its introduction in the 1980s, evolved to become a viable non-invasive alternative to echocardiography for a Woldendorp et al Journal of Cardiovascular Magnetic Resonance (2020) 22:45 the quality of the anatomical and functional information available from CMR. Diagnosis of AS, and severe AS is determined by a combination of mean and peak pressure gradients across the valve as well as the effective valve orifice, or aortic valve area (AVA) [2]. CMR provides high fidelity anatomical imaging, avoiding the need for additional imaging tools such as CT in the workup for valve intervention. This may be beneficial in patients with impaired renal function where high iodinated contrast loads required for CT imaging are contraindicated [7]. Advances in cardiovascular magnetic resonance (CMR) over the past two decades mean it is able to provide haemodynamic data at the aortic valve, along with high fidelity anatomical imaging
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