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Aliasing planimetry by phase-contrast imaging for grading of aortic stenosis severity

Session Poster session 2

Speaker Fabrizio Ricci

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Valve Disease
  • Session type : Poster Session

Authors : F Ricci (Chieti,IT), AL Caterino (Chieti,IT), C Mantini (Chieti,IT), D Rotondo (Chieti,IT), AR Cotroneo (Chieti,IT), S Gallina (Chieti,IT)

F Ricci1 , AL Caterino1 , C Mantini1 , D Rotondo2 , AR Cotroneo1 , S Gallina1 , 1University of Chieti-Pescara, Department of Neuroscience, Imaging and Clinical Sciences - Chieti - Italy , 2SS. Annunziata Hospital - Chieti - Italy ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii343

Transthoracic echocardiography (TTE) is the preferred technique for the assessment aortic stenosis (AS) and effective orifice area (EOA) is recommended as the best method for grading AS severity . Nevertheless, EOA is operator-dependent, influenced by a number of potential pitfalls and derived from the continuity equation, which requires three different measurements, yielding independent and random sources of error, increasing the propagation error probability eventually affecting the overall accuracy and precision of the measurement. In this study, we aimed to test the diagnostic accuracy of the aliased orifice area (AOA) planimetry, a novel non-invasive technique for grading of AS severity by low-VENC phase-contrast CMR imaging.
Twenty-two consecutive patients with a diagnosis of moderate (0.85cm2/m2 = indexed EOA = 0.6cm2/m2) or severe AS (indexed EOA<0.6 cm2/m2) and 6 age- and sex-matched healthy volunteers underwent unenhanced CMR and TTE examinations. We performed a comprehensive analysis of the agreement and correlation among i) AOA planimetry by low-VENC phase-contrast CMR imaging, ii) geometrical orifice area (GOA) valve planimetry by CMR, iii) EOA by TTE (continuity equation method), and iv) multimodality hybrid EOA (EOAhybrid), as obtained by substituting the LVOT area by CMR into the Doppler continuity equation. Using a 3-chamber cine view for reference, a phase-contrast slice was prescribed through the tips of aortic valve leaflets, then by setting the VENC value down to 40-50 cm/s, with NEX of 5 and free-breathing acquisition, an aliased flow signal was detected. AOA planimetry was measured by contouring the aliasing artifact at its largest systolic appearance on phase-velocity maps. Correlations and agreement were assessed with the use of Pearson’s correlation and Bland-Altman method.
AOA showed excellent inter-examination, intra-rater and inter-rater reliability (ICC: 0.953; 0.997; 0.998, respectively). We observed excellent pairwise correlation among AOA, EOAhybrid, GOA and EOA (P<0.001), AOA yielding the highest grade of correlation with EOAhybrid (R2=0.985, P<0.001). Bland–Altman analysis demonstrated good agreement between different methods, with the lowest bias of 0,019 for the comparison between EOAhybrid and AOA. When assuming EOAhybrid as the gold standard, AOA exhibited the lowest discordant grading rate (11%) compared with EOA and GOA (21% and 31% respectively; P<0.001).
Aliased orifice area planimetry by low-VENC phase-contrast imaging is a simple, reproducible and accurate one-off measurement technique for grading of severity of aortic stenosis. Larger studies are warranted to confirm our preliminary results.

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