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Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis
Purpose: In aortic stenosis (AS), the discrepancy between moderately accelerated flow and effective orifice area (EOA) continues to pose a challenge. We developed a method of measuring the vena contracta area as hemodynamic EOA using cardiac MRI focusing on AS patients with a moderately accelerated...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Japanese Society for Magnetic Resonance in Medicine
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9618929/ https://www.ncbi.nlm.nih.gov/pubmed/34334586 http://dx.doi.org/10.2463/mrms.mp.2021-0001 |
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author | Hohri, Yu Itatani, Keiichi Matsuo, Akiko Komori, Yoshiaki Okamoto, Takeshi Goto, Tomoyuki Kobayashi, Takuma Hiramatsu, Takeshi Miyazaki, Shohei Nishino, Teruyasu Yaku, Hitoshi |
author_facet | Hohri, Yu Itatani, Keiichi Matsuo, Akiko Komori, Yoshiaki Okamoto, Takeshi Goto, Tomoyuki Kobayashi, Takuma Hiramatsu, Takeshi Miyazaki, Shohei Nishino, Teruyasu Yaku, Hitoshi |
author_sort | Hohri, Yu |
collection | PubMed |
description | Purpose: In aortic stenosis (AS), the discrepancy between moderately accelerated flow and effective orifice area (EOA) continues to pose a challenge. We developed a method of measuring the vena contracta area as hemodynamic EOA using cardiac MRI focusing on AS patients with a moderately accelerated flow to solve the problem that AS severity can currently be determined only by echocardiography. Methods: We investigated 40 patients with a peak transvalvular velocity > 3.0 m/s on transthoracic echocardiography (TTE). The patients were divided into highly accelerated and moderately accelerated AS groups according to whether or not the peak transvalvular velocity was ≥ 4.0 m/s. From the multislice 2D cine phase-contrast MRI data, the cross-sectional area of the vena contracta of the reconstructed streamline in the Valsalva sinus was defined as MRI-EOAs. Patient symptoms and echocardiography data, including EOA (defined as TTE-EOA), were derived from the continuity equation using TTE. Results: All participants in the highly accelerated AS group (n = 19) showed a peak velocity ≥ 4.0 m/s in MRI. Eleven patients in the moderately accelerated AS group (n = 21) had a TTE-EOA < 1.00 cm(2). In the moderately accelerated AS group, MRI-EOAs demonstrated a strong correlation with TTE-EOAs (r = 0.76, P < 0.01). Meanwhile, in the highly accelerated AS group, MRI-EOAs demonstrated positivity but a moderate correlation with TTE-EOAs (r = 0.63, P = 0.004). MRI-EOAs were overestimated compared to TTE-EOAs. In terms of the moderately accelerated AS group, the best cut-off value for MRI-EOAs was < 1.23 cm(2), compatible with TTE-EOAs < 1.00 cm(2), with an excellent prediction of the New York Heart Association classification ≥ III (sensitivity 87.5%, specificity 76.9%). Conclusion: MRI-EOAs may be an alternative to conventional echocardiography for patients with moderately accelerated AS, especially those with discordant echocardiographic parameters. |
format | Online Article Text |
id | pubmed-9618929 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Japanese Society for Magnetic Resonance in Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-96189292022-11-14 Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis Hohri, Yu Itatani, Keiichi Matsuo, Akiko Komori, Yoshiaki Okamoto, Takeshi Goto, Tomoyuki Kobayashi, Takuma Hiramatsu, Takeshi Miyazaki, Shohei Nishino, Teruyasu Yaku, Hitoshi Magn Reson Med Sci Major Paper Purpose: In aortic stenosis (AS), the discrepancy between moderately accelerated flow and effective orifice area (EOA) continues to pose a challenge. We developed a method of measuring the vena contracta area as hemodynamic EOA using cardiac MRI focusing on AS patients with a moderately accelerated flow to solve the problem that AS severity can currently be determined only by echocardiography. Methods: We investigated 40 patients with a peak transvalvular velocity > 3.0 m/s on transthoracic echocardiography (TTE). The patients were divided into highly accelerated and moderately accelerated AS groups according to whether or not the peak transvalvular velocity was ≥ 4.0 m/s. From the multislice 2D cine phase-contrast MRI data, the cross-sectional area of the vena contracta of the reconstructed streamline in the Valsalva sinus was defined as MRI-EOAs. Patient symptoms and echocardiography data, including EOA (defined as TTE-EOA), were derived from the continuity equation using TTE. Results: All participants in the highly accelerated AS group (n = 19) showed a peak velocity ≥ 4.0 m/s in MRI. Eleven patients in the moderately accelerated AS group (n = 21) had a TTE-EOA < 1.00 cm(2). In the moderately accelerated AS group, MRI-EOAs demonstrated a strong correlation with TTE-EOAs (r = 0.76, P < 0.01). Meanwhile, in the highly accelerated AS group, MRI-EOAs demonstrated positivity but a moderate correlation with TTE-EOAs (r = 0.63, P = 0.004). MRI-EOAs were overestimated compared to TTE-EOAs. In terms of the moderately accelerated AS group, the best cut-off value for MRI-EOAs was < 1.23 cm(2), compatible with TTE-EOAs < 1.00 cm(2), with an excellent prediction of the New York Heart Association classification ≥ III (sensitivity 87.5%, specificity 76.9%). Conclusion: MRI-EOAs may be an alternative to conventional echocardiography for patients with moderately accelerated AS, especially those with discordant echocardiographic parameters. Japanese Society for Magnetic Resonance in Medicine 2021-07-30 /pmc/articles/PMC9618929/ /pubmed/34334586 http://dx.doi.org/10.2463/mrms.mp.2021-0001 Text en ©2021 Japanese Society for Magnetic Resonance in Medicine https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Major Paper Hohri, Yu Itatani, Keiichi Matsuo, Akiko Komori, Yoshiaki Okamoto, Takeshi Goto, Tomoyuki Kobayashi, Takuma Hiramatsu, Takeshi Miyazaki, Shohei Nishino, Teruyasu Yaku, Hitoshi Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis |
title | Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis |
title_full | Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis |
title_fullStr | Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis |
title_full_unstemmed | Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis |
title_short | Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis |
title_sort | estimating the haemodynamic streamline vena contracta as the effective orifice area measured from reconstructed multislice phase-contrast mr images for patients with moderately accelerated aortic stenosis |
topic | Major Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9618929/ https://www.ncbi.nlm.nih.gov/pubmed/34334586 http://dx.doi.org/10.2463/mrms.mp.2021-0001 |
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