Validation of aortic valve pressure gradient quantification using semi-automated 4D flow CMR pipeline

BMC Research Notes, vol. 15, pp. 151

Abstract

OBJECTIVE: Doppler echocardiographic aortic valve peak velocity and peak pressure gradient assessment across the aortic valve (AV) is the mainstay for diagnosing aortic stenosis. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is emerging as a valuable diagnostic tool for estimating the peak pressure drop across the aortic valve, but assessment remains cumbersome. We aimed to validate a novel semi-automated pipeline 4D flow CMR method of assessing peak aortic value pressure gradient (AVPG) using the commercially available software solution, CAAS MR Solutions, against invasive angiographic methods. RESULTS: We enrolled 11 patients with severe AS on echocardiography from the EurValve programme. All patients had pre-intervention doppler echocardiography, invasive cardiac catheterisation with peak pressure drop assessment across the AV and 4D flow CMR. The peak AVPG was 51.9 ± 35.2 mmHg using the invasive pressure drop method and 52.2 ± 29.2 mmHg for the 4D flow CMR method (semi-automated pipeline), with good correlation between the two methods (r = 0.70, p = 0.017). Assessment of AVPG by 4D flow CMR using the novel semi-automated pipeline method shows excellent agreement to invasive assessment when compared to doppler-based methods and advocate for its use as complementary to echocardiography.

Authors 12

1. Ciaran Grafton‐Clarke

   University of East Anglia

   Affiliation as printed

   Norwich Medical School, University of East Anglia, Norwich, S10 2RX, UK

2. Paul Njoku

   University of East Anglia

   Affiliation as printed

   Norwich Medical School, University of East Anglia, Norwich, S10 2RX, UK

3. Jean‐Paul Aben
   Affiliation as printed

   Pie Medical Imaging, Maastricht, The Netherlands

4. Léon A.F. Ledoux
   Affiliation as printed

   Pie Medical Imaging, Maastricht, The Netherlands

5. Liang Zhong

   National Heart Centre Singapore

   Affiliation as printed

   National Heart Centre, Singapore, Singapore

6. Jos J.M. Westenberg Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leids Universitair Medisch Centrum, Leiden, The Netherlands

7. Andrew J. Swift

   University of Sheffield

   Affiliation as printed

   University of Sheffield, Sheffield, UK

8. Gareth T. Archer

   University of Sheffield

   Affiliation as printed

   University of Sheffield, Sheffield, UK

9. Rod Hose

   University of Sheffield

   Affiliation as printed

   University of Sheffield, Sheffield, UK

10. Marcus D Flather

    University of East Anglia

    Affiliation as printed

    Norwich Medical School, University of East Anglia, Norwich, S10 2RX, UK

11. Vassilios S. Vassiliou

    University of East Anglia

    Affiliation as printed

    Norwich Medical School, University of East Anglia, Norwich, S10 2RX, UK

12. Pankaj Garg corresponding

    University of East Anglia

    Affiliation as printed

    Norwich Medical School, University of East Anglia, Norwich, S10 2RX, UK. p.garg@uea.ac.uk

    Norwich Medical School, University of East Anglia, Norwich, S10 2RX, UK