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January 01, 2025 article Open access Aachen paper

Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis

Open Heart, vol. 12, pp. e003081

DOI: 10.1136/openhrt-2024-003081 Full text (OA) OpenAlex

Abstract

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 (V Peak ), 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 (V Peak , AV area and mean pressure gradient) and CMR-derived V Peak . Results The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V Peak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V Peak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V Peak 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 V Peak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V Peak (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 V Peak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention. Trial registration number NCT05114785 .

Authors 20

  1. Ciaran Grafton‐Clarke

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  2. Hosamadin S. Assadi

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  3. Rui Li

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  4. Zia Mehmood

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  5. Rimma Hall

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  6. Gareth D. K. Matthews

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  7. Vasiliki Tsampasian

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  8. Samer Alabed

    University of Sheffield

    Affiliation as printed

    Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK

  9. Bahman Kasmai

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  10. Laura Staff

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  11. Gurung-Koney Yashoda

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  12. Julia Sun

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  13. Kurian Thampi

    Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  14. Jordi Broncano
    Affiliation as printed

    Hospital San Juan de Dios, Santa Cruz de Tenerife, Spain

  15. Fabrizio Ricci

    University of Chieti-Pescara

    Affiliation as printed

    Department of Neuroscience, Imaging and Clinical Sciences, Chieti and University Cardiology Division, Chieti, Italy

  16. Peter Swoboda

    University of Leeds

    Affiliation as printed

    LICAMM, University of Leeds, Leeds, UK

  17. Andrew J. Swift

    University of Sheffield

    Affiliation as printed

    Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK

  18. Vassilios S. Vassiliou

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

  19. Rob J. van der Geest Aachen Department of Radiology Division of Image Processing (LKEB)

    Leiden University Medical Center

    Affiliation as printed

    Department of Radiology, Division of Image Processing, Leiden University Medical Center (LUMC), Leiden, The Netherlands

  20. Pankaj Garg

    University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust

    Affiliation as printed

    Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

    Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK p.garg@uea.ac.uk

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References 26