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Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study

Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent...

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Autores principales: Mantini, Cesare, Khanji, Mohammed Y., D'Ugo, Emilia, Olivieri, Marzia, Caputi, Cristiano Giovanni, Bufano, Gabriella, Mastrodicasa, Domenico, Calvo Garcia, Darien, Rotondo, Domenico, Candeloro, Matteo, Tana, Claudio, Cademartiri, Filippo, Ionescu, Adrian, Caulo, Massimo, Gallina, Sabina, Ricci, Fabrizio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558301/
https://www.ncbi.nlm.nih.gov/pubmed/34733896
http://dx.doi.org/10.3389/fcvm.2021.752340
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author Mantini, Cesare
Khanji, Mohammed Y.
D'Ugo, Emilia
Olivieri, Marzia
Caputi, Cristiano Giovanni
Bufano, Gabriella
Mastrodicasa, Domenico
Calvo Garcia, Darien
Rotondo, Domenico
Candeloro, Matteo
Tana, Claudio
Cademartiri, Filippo
Ionescu, Adrian
Caulo, Massimo
Gallina, Sabina
Ricci, Fabrizio
author_facet Mantini, Cesare
Khanji, Mohammed Y.
D'Ugo, Emilia
Olivieri, Marzia
Caputi, Cristiano Giovanni
Bufano, Gabriella
Mastrodicasa, Domenico
Calvo Garcia, Darien
Rotondo, Domenico
Candeloro, Matteo
Tana, Claudio
Cademartiri, Filippo
Ionescu, Adrian
Caulo, Massimo
Gallina, Sabina
Ricci, Fabrizio
author_sort Mantini, Cesare
collection PubMed
description Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOA(cmr)), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOA(cmr); (ii) geometric orifice area (GOA(cmr)) by direct CMR planimetry; (iii) EOA(echo) by TTE-continuity equation; and (iv) the “gold standard” multimodality EOA (EOA(hybrid)) obtained by substituting CMR LVOT area into Doppler continuity equation. Results: There was excellent pairwise positive linear correlation among AOA(cmr), EOA(hybrid), GOA(cmr), and EOA(echo) (p < 0.001); AOA(cmr) had the highest correlation with EOA(hybrid) (R(2) = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOA(cmr) and EOA(hybrid). AOA(cmr) yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.
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spelling pubmed-85583012021-11-02 Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study Mantini, Cesare Khanji, Mohammed Y. D'Ugo, Emilia Olivieri, Marzia Caputi, Cristiano Giovanni Bufano, Gabriella Mastrodicasa, Domenico Calvo Garcia, Darien Rotondo, Domenico Candeloro, Matteo Tana, Claudio Cademartiri, Filippo Ionescu, Adrian Caulo, Massimo Gallina, Sabina Ricci, Fabrizio Front Cardiovasc Med Cardiovascular Medicine Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOA(cmr)), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOA(cmr); (ii) geometric orifice area (GOA(cmr)) by direct CMR planimetry; (iii) EOA(echo) by TTE-continuity equation; and (iv) the “gold standard” multimodality EOA (EOA(hybrid)) obtained by substituting CMR LVOT area into Doppler continuity equation. Results: There was excellent pairwise positive linear correlation among AOA(cmr), EOA(hybrid), GOA(cmr), and EOA(echo) (p < 0.001); AOA(cmr) had the highest correlation with EOA(hybrid) (R(2) = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOA(cmr) and EOA(hybrid). AOA(cmr) yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate “one-stop shop” CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results. Frontiers Media S.A. 2021-10-18 /pmc/articles/PMC8558301/ /pubmed/34733896 http://dx.doi.org/10.3389/fcvm.2021.752340 Text en Copyright © 2021 Mantini, Khanji, D'Ugo, Olivieri, Caputi, Bufano, Mastrodicasa, Calvo Garcia, Rotondo, Candeloro, Tana, Cademartiri, Ionescu, Caulo, Gallina and Ricci. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Mantini, Cesare
Khanji, Mohammed Y.
D'Ugo, Emilia
Olivieri, Marzia
Caputi, Cristiano Giovanni
Bufano, Gabriella
Mastrodicasa, Domenico
Calvo Garcia, Darien
Rotondo, Domenico
Candeloro, Matteo
Tana, Claudio
Cademartiri, Filippo
Ionescu, Adrian
Caulo, Massimo
Gallina, Sabina
Ricci, Fabrizio
Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study
title Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study
title_full Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study
title_fullStr Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study
title_full_unstemmed Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study
title_short Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study
title_sort aliased flow signal planimetry by cardiovascular magnetic resonance imaging for grading aortic stenosis severity: a prospective pilot study
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558301/
https://www.ncbi.nlm.nih.gov/pubmed/34733896
http://dx.doi.org/10.3389/fcvm.2021.752340
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