Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis
Aims Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (VPeak), gradin...
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BMJ Publishing Group
2025-05-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003081.full |
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| author | Samer Alabed Pankaj Garg Rui Li Julia Sun John Curtin Fabrizio Ricci Andrew J Swift Ciaran Grafton-Clarke Peter Swoboda David Hewson Hosamadin Assadi Rimma Hall Vassilios S Vassiliou Vasiliki Tsampasian Gareth Matthews Zia Mehmood Bahman Kasmai Gurung-Koney Yashoda Rob J van der Geest Sunil Nair Laura Staff Kurian Thampi Jordi Broncano |
| author_facet | Samer Alabed Pankaj Garg Rui Li Julia Sun John Curtin Fabrizio Ricci Andrew J Swift Ciaran Grafton-Clarke Peter Swoboda David Hewson Hosamadin Assadi Rimma Hall Vassilios S Vassiliou Vasiliki Tsampasian Gareth Matthews Zia Mehmood Bahman Kasmai Gurung-Koney Yashoda Rob J van der Geest Sunil Nair Laura Staff Kurian Thampi Jordi Broncano |
| author_sort | Samer Alabed |
| collection | DOAJ |
| description | Aims Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (VPeak), grading AS severity and predicting AV intervention in a real-world setting.Methods Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included. AS severity was graded using established protocols using three echocardiographic parameters (VPeak, AV area and mean pressure gradient) and CMR-derived VPeak.Results The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) VPeak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow VPeak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. VPeak by CWD was significantly lower to 4D flow with a bias of −0.5 (p=0.01) and a correlation of (R=0.55, p=0.002). The Cox-regression analysis reveals that 4D flow VPeak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD VPeak (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ²=9.5, p=0.02).Conclusion 4D flow CMR-derived VPeak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.Trial registration number NCT05114785. |
| format | Article |
| id | doaj-art-5eef6465207744a89c4fbd9d173a35cb |
| institution | OA Journals |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-5eef6465207744a89c4fbd9d173a35cb2025-08-20T02:28:32ZengBMJ Publishing GroupOpen Heart2053-36242025-05-0112110.1136/openhrt-2024-003081Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosisSamer Alabed0Pankaj Garg1Rui Li2Julia Sun3John Curtin4Fabrizio Ricci5Andrew J Swift6Ciaran Grafton-Clarke7Peter Swoboda8David Hewson9Hosamadin Assadi10Rimma Hall11Vassilios S Vassiliou12Vasiliki Tsampasian13Gareth Matthews14Zia Mehmood15Bahman Kasmai16Gurung-Koney Yashoda17Rob J van der Geest18Sunil Nair19Laura Staff20Kurian Thampi21Jordi Broncano22Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKDepartment of Neuroscience, Imaging and Clinical Sciences, Chieti and University Cardiology Division, Chieti, ItalyDepartment of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKLICAMM, University of Leeds, Leeds, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKDepartment of Radiology, Division of Image Processing, Leiden University Medical Center (LUMC), Leiden, The NetherlandsNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UKHospital San Juan de Dios, Santa Cruz de Tenerife, SpainAims Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (VPeak), grading AS severity and predicting AV intervention in a real-world setting.Methods Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included. AS severity was graded using established protocols using three echocardiographic parameters (VPeak, AV area and mean pressure gradient) and CMR-derived VPeak.Results The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) VPeak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow VPeak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. VPeak by CWD was significantly lower to 4D flow with a bias of −0.5 (p=0.01) and a correlation of (R=0.55, p=0.002). The Cox-regression analysis reveals that 4D flow VPeak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD VPeak (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ²=9.5, p=0.02).Conclusion 4D flow CMR-derived VPeak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.Trial registration number NCT05114785.https://openheart.bmj.com/content/12/1/e003081.full |
| spellingShingle | Samer Alabed Pankaj Garg Rui Li Julia Sun John Curtin Fabrizio Ricci Andrew J Swift Ciaran Grafton-Clarke Peter Swoboda David Hewson Hosamadin Assadi Rimma Hall Vassilios S Vassiliou Vasiliki Tsampasian Gareth Matthews Zia Mehmood Bahman Kasmai Gurung-Koney Yashoda Rob J van der Geest Sunil Nair Laura Staff Kurian Thampi Jordi Broncano Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis Open Heart |
| title | Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis |
| title_full | Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis |
| title_fullStr | Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis |
| title_full_unstemmed | Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis |
| title_short | Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis |
| title_sort | four dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis |
| url | https://openheart.bmj.com/content/12/1/e003081.full |
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