Ciaran Grafton-Clarke, Hosamadin Assadi, Rui Li, Zia Mehmood, Rimma Hall, Gareth Matthews, Vasiliki Tsampasian, Samer Alabed, Bahman Kasmai, Laura Staff, John Curtin, Gurung-Koney Yashoda, Julia Sun, Sunil Nair, David Hewson, Kurian Thampi, Jordi Broncano, Fabrizio Ricci, Peter Swoboda, Andrew J Swift, Vassilios S Vassiliou, Rob J van der Geest, Pankaj Garg
{"title":"四维血流比超声心动图对主动脉狭窄的诊断价值更高。","authors":"Ciaran Grafton-Clarke, Hosamadin Assadi, Rui Li, Zia Mehmood, Rimma Hall, Gareth Matthews, Vasiliki Tsampasian, Samer Alabed, Bahman Kasmai, Laura Staff, John Curtin, Gurung-Koney Yashoda, Julia Sun, Sunil Nair, David Hewson, Kurian Thampi, Jordi Broncano, Fabrizio Ricci, Peter Swoboda, Andrew J Swift, Vassilios S Vassiliou, Rob J van der Geest, Pankaj Garg","doi":"10.1136/openhrt-2024-003081","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>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<sub>Peak</sub>), grading AS severity and predicting AV intervention in a real-world setting.</p><p><strong>Methods: </strong>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<sub>Peak</sub>, AV area and mean pressure gradient) and CMR-derived V<sub>Peak</sub>.</p><p><strong>Results: </strong>The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V<sub>Peak</sub> (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V<sub>Peak</sub> (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V<sub>Peak</sub> 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<sub>Peak</sub> significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V<sub>Peak</sub> (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ²=9.5, p=0.02).</p><p><strong>Conclusion: </strong>4D flow CMR-derived V<sub>Peak</sub> assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.</p><p><strong>Trial registration number: </strong>NCT05114785.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060880/pdf/","citationCount":"0","resultStr":"{\"title\":\"Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis.\",\"authors\":\"Ciaran Grafton-Clarke, Hosamadin Assadi, Rui Li, Zia Mehmood, Rimma Hall, Gareth Matthews, Vasiliki Tsampasian, Samer Alabed, Bahman Kasmai, Laura Staff, John Curtin, Gurung-Koney Yashoda, Julia Sun, Sunil Nair, David Hewson, Kurian Thampi, Jordi Broncano, Fabrizio Ricci, Peter Swoboda, Andrew J Swift, Vassilios S Vassiliou, Rob J van der Geest, Pankaj Garg\",\"doi\":\"10.1136/openhrt-2024-003081\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>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<sub>Peak</sub>), grading AS severity and predicting AV intervention in a real-world setting.</p><p><strong>Methods: </strong>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<sub>Peak</sub>, AV area and mean pressure gradient) and CMR-derived V<sub>Peak</sub>.</p><p><strong>Results: </strong>The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V<sub>Peak</sub> (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V<sub>Peak</sub> (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V<sub>Peak</sub> 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<sub>Peak</sub> significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V<sub>Peak</sub> (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ²=9.5, p=0.02).</p><p><strong>Conclusion: </strong>4D flow CMR-derived V<sub>Peak</sub> assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.</p><p><strong>Trial registration number: </strong>NCT05114785.</p>\",\"PeriodicalId\":19505,\"journal\":{\"name\":\"Open Heart\",\"volume\":\"12 1\",\"pages\":\"\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060880/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Heart\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/openhrt-2024-003081\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Heart","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/openhrt-2024-003081","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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), 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.
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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