1
|
Chuah SH, Tan LK, Md Sari NA, Chan BT, Hasikin K, Lim E, Ung NM, Abdul Aziz YF, Jayabalan J, Liew YM. Remodeling in Aortic Stenosis With Reduced and Preserved Ejection Fraction: Insight on Motion Abnormality Via 3D + Time Personalized LV Modeling in Cardiac MRI. J Magn Reson Imaging 2024; 59:1242-1255. [PMID: 37452574 DOI: 10.1002/jmri.28915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Increased afterload in aortic stenosis (AS) induces left ventricle (LV) remodeling to preserve a normal ejection fraction. This compensatory response can become maladaptive and manifest with motion abnormality. It is a clinical challenge to identify contractile and relaxation dysfunction during early subclinical stage to prevent irreversible deterioration. PURPOSE To evaluate the changes of regional wall dynamics in 3D + time domain as remodeling progresses in AS. STUDY TYPE Retrospective. POPULATION A total of 31 AS patients with reduced and preserved ejection fraction (14 AS_rEF: 7 male, 66.5 [7.8] years old; 17 AS_pEF: 12 male, 67.0 [6.0] years old) and 15 healthy (6 male, 61.0 [7.0] years old). FIELD STRENGTH/SEQUENCE 1.5 T Magnetic resonance imaging/steady state free precession and late-gadolinium enhancement sequences. ASSESSMENT Individual LV models were reconstructed in 3D + time domain and motion metrics including wall thickening (TI), dyssynchrony index (DI), contraction rate (CR), and relaxation rate (RR) were automatically extracted and associated with the presence of scarring and remodeling. STATISTICAL TESTS Shapiro-Wilk: data normality; Kruskal-Wallis: significant difference (P < 0.05); ICC and CV: variability; Mann-Whitney: effect size. RESULTS AS_rEF group shows distinct deterioration of cardiac motions compared to AS_pEF and healthy groups (TIAS_rEF : 0.92 [0.85] mm, TIAS_pEF : 5.13 [1.99] mm, TIhealthy : 3.61 [1.09] mm, ES: 0.48-0.83; DIAS_rEF : 17.11 [7.89]%, DIAS_pEF : 6.39 [4.04]%, DIhealthy : 5.71 [1.87]%, ES: 0.32-0.85; CRAS_rEF : 8.69 [6.11] mm/second, CRAS_pEF : 16.48 [6.70] mm/second, CRhealthy : 10.82 [4.57] mm/second, ES: 0.29-0.60; RRAS_rEF : 8.45 [4.84] mm/second; RRAS_pEF : 13.49 [8.56] mm/second, RRhealthy : 9.31 [2.48] mm/second, ES: 0.14-0.43). The difference in the motion metrics between healthy and AS_pEF groups were insignificant (P-value = 0.16-0.72). AS_rEF group was dominated by eccentric hypertrophy (47.1%) with concomitant scarring. Conversely, AS_pEF group was dominated by concentric remodeling and hypertrophy (71.4%), which could demonstrate hyperkinesia with slight wall dyssynchrony than healthy. Dysfunction of LV mechanics corresponded to the presence of myocardial scarring (54.9% in AS), which reverted the compensatory mechanisms initiated and performed by LV remodeling. DATA CONCLUSION The proposed 3D + time modeling technique may distinguish regional motion abnormalities between AS_pEF, AS_rEF, and healthy cohorts, aiding clinical diagnosis and monitoring of AS progression. Subclinical myocardial dysfunction is evident in early AS despite of normal EF. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 1.
Collapse
Affiliation(s)
- Shoon Hui Chuah
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nor Ashikin Md Sari
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Khairunnisa Hasikin
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ngie Min Ung
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jeyaraaj Jayabalan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
2
|
Troger F, Kremser C, Pamminger M, Reinstadler SJ, Thurner GC, Henninger B, Klug G, Metzler B, Mayr A. Functional aortic valve area differs significantly between sexes: A phase-contrast cardiac MRI study in patients with severe aortic stenosis. IJC HEART & VASCULATURE 2024; 51:101357. [PMID: 38356930 PMCID: PMC10863308 DOI: 10.1016/j.ijcha.2024.101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Background Aortic stenosis (AS) is one of the most prevalent valvular heart-diseases in Europe. Currently, diagnosis and classification are not sex-sensitive; however, due to a distinctly different natural history of AS, further investigations of sex-differences in AS-patients are needed. Thus, this study aimed to detect sex-differences in severe AS, especially concerning flow-patterns, via phase-contrast cardiac magnetic resonance imaging (PC-CMR). Methods Forty-four severe AS-patients (20 women, 45 % vs. 24 men, 55 %) with a median age of 72 years underwent transthoracic echocardiography (TTE), cardiac catheterization (CC) and CMR. Aortic valve area (AVA) and stroke volume (SV) were determined in all modalities, with CMR yielding geometrical AVA via cine-planimetry and functional AVA via PC-CMR, the latter being also used to examine flow-properties. Results Geometrical AVA showed no sex-differences (0.91 cm2, IQR: 0.61-1.14 vs. 0.94 cm2, IQR: 0.77-1.22, p = 0.322). However, functional AVA differed significantly between sexes in all three modalities (TTE: p = 0.044; CC/PC-CMR: p < 0.001). In men, no significant intermethodical biases in functional AVA-measurements between modalities were found (p = 0.278); yet, in women the particular measurements differed significantly (p < 0.001). Momentary flowrate showed sex-differences depending on momentary opening-degree (at 50 %, 75 % and 90 % of peak-AVA, all p < 0.001), with men showing higher flowrates with increasing opening-area. In women, flowrate did not differ between 75 % and 90 % of peak-AVA (p = 0.191). Conclusions In severe AS-patients, functional AVA showed marked sex-differences in all modalities, whilst geometrical AVA did not differ. Inter-methodical biases were negligible in men, but not in women. Lastly, significant sex-differences in flow-patterns fit in with the different pathogenesis of AS.
Collapse
Affiliation(s)
- Felix Troger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Christian Kremser
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Gudrun C Thurner
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44 6020, Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Gert Klug
- Department of Internal Medicine, County Hospital Bruck an der Mur, Tragoesser Strasse 1 8600, Bruck an der Mur, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck, Austria
| |
Collapse
|
3
|
Alaour B, Nakase M, Pilgrim T. Combined Significant Aortic Stenosis and Mitral Regurgitation: Challenges in Timing and Type of Intervention. Can J Cardiol 2024; 40:235-249. [PMID: 37931671 DOI: 10.1016/j.cjca.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
In this narrative review, we aim to summarize the literature surrounding the assessment and management of the common, yet understudied combination of aortic stenosis (AS) and mitral regurgitation (MR), the components of which are complexly inter-related and interdependent from diagnostic, prognostic, and therapeutic perspectives. The hemodynamic interdependency of AS and MR confounds the assessment of the severity of each valve disease, thus underscoring the importance of a multimodal approach integrating valvular and extravalvular indicators of severity. A large body of literature suggests that baseline MR is associated with reduced survival post aortic valve (AV) intervention and that regression of MR post-AV intervention confers a mortality benefit. Functional MR is more likely to regress after AV intervention than primary MR. The respective natural courses of the 2 valve diseases are not synchronized; therefore, significant AS and MR at or above the respective threshold for intervention might not coincide. Surgery is primarily a 1-stop-shop procedure because of a considerable perioperative risk of repeat interventions, whereas transcatheter treatment modalities allow for a more tailored timing of intervention with reassessment of concomitant MR after AV replacement and a potential staged intervention in the absence of MR regression. In summary, AS and MR, when combined, are interlaced into a complex hemodynamic, diagnostic, and prognostic synergy, with important therapeutic implications. Contemporary approaches should consider stepwise intervention by exploiting the advantage of transcatheter options. However, evidence is needed to demonstrate the efficacy of different timing and therapeutic options.
Collapse
Affiliation(s)
- Bashir Alaour
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Masaaki Nakase
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
4
|
Choe J, Koo HJ, Choi SJ, Lee SA, Kim DH, Song JM, Kang DH, Song JK, Kang JW, Yang DH. Differences in aortic valve area measured on cardiac CT and echocardiography in patients with aortic stenosis. PLoS One 2023; 18:e0280530. [PMID: 36662795 PMCID: PMC9858019 DOI: 10.1371/journal.pone.0280530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A certain proportion of patients with severe aortic stenosis (AS) present with discordant grading between different diagnostic modalities, which raises uncertainty about the true severity of AS. The aim of this study was to compare the aortic valve area (AVA) measured on CT and echocardiography and demonstrate the factors affecting AVA discrepancies. METHODS Between June 2011 and March 2016, 535 consecutive patients (66.83±8.80 years, 297 men) with AS who underwent pre-operative cardiac CT and echocardiography for aortic valve replacement were retrospectively included. AVA was obtained by AVA on echocardiography (AVAecho) and CT (AVACT) using a measurement of the left ventricular outflow tract on each modality and correlations between those measures were evaluated. Logistic regression analysis was performed to identify factors affecting the discordance for grading severe AS. RESULTS The AVACT and AVAecho showed a high correlation (r: 0.79, P <0.001) but AVACT was larger than the AVAecho (difference 0.26 cm2, P <0.001). By using the cut-off values of AVACT (<1.2 cm2) and AVAecho (<1.0 cm2) for diagnosing severe AS, the BSA (odds ratio [OR]: 68.03, 95% confidence interval [CI]: 5.45-849.99; P = 0.001), AVAecho (OR: 1.19, 95%CI: 1.14-1.24; P <0.001), tricuspid valve morphology (OR: 2.83, 95%CI: 1.23-6.50; P = 0.01), and normalized annulus area (OR: 1.02; 95%CI:1.02-1.03; P <0.001) were significant factors associated with the discordance between the AVAecho and AVACT. CONCLUSION Patients with larger BSA, AVAecho, and annulus, and tricuspid valve morphology were associated with the AVA discordance between the echocardiography and CT. Complementary use of CT with echocardiography for grading severe AS could be helpful in such conditions.
Collapse
Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Se Jin Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| |
Collapse
|
5
|
Singh A, Chan DCS, Kanagala P, Hogrefe K, Kelly DJ, Khoo JP, Sprigings D, Greenwood JP, Abdelaty AMSEK, Jerosch-Herold M, Ng LL, McCann GP. Short-term adverse remodeling progression in asymptomatic aortic stenosis. Eur Radiol 2021; 31:3923-3930. [PMID: 33215248 PMCID: PMC8128853 DOI: 10.1007/s00330-020-07462-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/07/2020] [Accepted: 11/03/2020] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Aortic stenosis (AS) is characterised by a long and variable asymptomatic course. Our objective was to use cardiovascular magnetic resonance imaging (MRI) to assess progression of adverse remodeling in asymptomatic AS. METHODS Participants from the PRIMID-AS study, a prospective, multi-centre observational study of asymptomatic patients with moderate to severe AS, who remained asymptomatic at 12 months, were invited to undergo a repeat cardiac MRI. RESULTS Forty-three participants with moderate-severe AS (mean age 64.4 ± 14.8 years, 83.4% male, aortic valve area index 0.54 ± 0.15 cm2/m2) were included. There was small but significant increase in indexed left ventricular (LV) (90.7 ± 22.0 to 94.5 ± 23.1 ml/m2, p = 0.007) and left atrial volumes (52.9 ± 11.3 to 58.6 ± 13.6 ml/m2, p < 0.001), with a decrease in systolic (LV ejection fraction 57.9 ± 4.6 to 55.6 ± 4.1%, p = 0.001) and diastolic (longitudinal diastolic strain rate 1.06 ± 0.2 to 0.99 ± 0.2 1/s, p = 0.026) function, but no overall change in LV mass or mass/volume. Late gadolinium enhancement increased (2.02 to 4.26 g, p < 0.001) but markers of diffuse interstitial fibrosis did not change significantly (extracellular volume index 12.9 [11.4, 17.0] ml/m2 to 13.3 [11.1, 15.1] ml/m2, p = 0.689). There was also a significant increase in the levels of NT-proBNP (43.6 [13.45, 137.08] pg/ml to 53.4 [19.14, 202.20] pg/ml, p = 0.001). CONCLUSIONS There is progression in cardiac remodeling with increasing scar burden even in asymptomatic AS. Given the lack of reversibility of LGE post-AVR and its association with long-term mortality post-AVR, this suggests the potential need for earlier intervention, before the accumulation of LGE, to improve the long-term outcomes in AS. KEY POINTS • Current guidelines recommend waiting until symptom onset before valve replacement in severe AS. • MRI showed clear progression in cardiac remodeling over 12 months in asymptomatic patients with AS, with near doubling in LGE. • This highlights the need for potentially earlier intervention or better risk stratification in AS.
Collapse
Affiliation(s)
- Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK.
| | - Daniel C S Chan
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK
| | - Prathap Kanagala
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK
- Department of Cardiology, Aintree University Hospital, Liverpool, UK
| | - Kai Hogrefe
- Cardiology Department, Kettering General Hospital Foundation Trust, Rothwell Rd, Kettering, NN16 8UZ, UK
| | - Damian J Kelly
- Cardiology Department, Royal Derby Hospital, Uttoxeter Rd, Derby, DE22 3NE, UK
| | - Jeffery P Khoo
- Cardiology Department, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - David Sprigings
- Northampton General Hospital, Cliftonville, Northampton, NN1 5BD, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular & Metabolic Medicine, Leeds University, Leeds, LS2 9JT, UK
| | - Ahmed M S E K Abdelaty
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK
- Cardiology Department, Suez Canal University, Ring road, Ismailia, 41611, Egypt
| | - Michael Jerosch-Herold
- Brigham and Woman's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK
| |
Collapse
|
6
|
Kim HJ, Choe YH, Kim SM, Kim EK, Lee M, Park SJ, Ahn J, Carriere KC. A New Method for Aortic Valve Planimetry with High-Resolution 3-Dimensional MRI and Its Comparison with Conventional Cine MRI and Echocardiography for Assessing the Severity of Aortic Valvular Stenosis. Korean J Radiol 2021; 22:1266-1278. [PMID: 33938648 PMCID: PMC8316769 DOI: 10.3348/kjr.2020.1218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/01/2020] [Accepted: 12/31/2020] [Indexed: 12/30/2022] Open
Abstract
Objective We aimed to compare the aortic valve area (AVA) calculated using fast high-resolution three-dimensional (3D) magnetic resonance (MR) image acquisition with that of the conventional two-dimensional (2D) cine MR technique. Materials and Methods We included 139 consecutive patients (mean age ± standard deviation [SD], 68.5 ± 9.4 years) with aortic valvular stenosis (AS) and 21 asymptomatic controls (52.3 ± 14.2 years). High-resolution T2-prepared 3D steady-state free precession (SSFP) images (2.0 mm slice thickness, 10 contiguous slices) for 3D planimetry (3DP) were acquired with a single breath hold during mid-systole. 2D SSFP cine MR images (6.0 mm slice thickness) for 2D planimetry (2DP) were also obtained at three aortic valve levels. The calculations for the effective AVA based on the MR images were compared with the transthoracic echocardiographic (TTE) measurements using the continuity equation. Results The mean AVA ± SD derived by 3DP, 2DP, and TTE in the AS group were 0.81 ± 0.26 cm2, 0.82 ± 0.34 cm2, and 0.80 ± 0.26 cm2, respectively (p = 0.366). The intra-observer agreement was higher for 3DP than 2DP in one observer: intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval [CI], 0.94–0.97) and 0.87 (95% CI, 0.82–0.91), respectively, for observer 1 and 0.97 (95% CI, 0.96–0.98) and 0.98 (95% CI, 0.97–0.99), respectively, for observer 2. Inter-observer agreement was similar between 3DP and 2DP, with the ICC of 0.92 (95% CI, 0.89–0.94) and 0.91 (95% CI, 0.88–0.93), respectively. 3DP-derived AVA showed a slightly higher agreement with AVA measured by TTE than the 2DP-derived AVA, with the ICC of 0.87 (95% CI, 0.82–0.91) vs. 0.85 (95% CI, 0.79–0.89). Conclusion High-resolution 3D MR image acquisition, with single-breath-hold SSFP sequences, gave AVA measurement with low observer variability that correlated highly with those obtained by TTE.
Collapse
Affiliation(s)
- Hae Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Radiology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,HVSI Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,HVSI Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- HVSI Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mirae Lee
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sung Ji Park
- HVSI Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joonghyun Ahn
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Keumhee C Carriere
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
7
|
Zhong Z, Sun K, Dan G, Luo Q, Farzaneh-Far A, Karaman MM, Zhou XJ. Visualization of Human Aortic Valve Dynamics Using Magnetic Resonance Imaging with Sub-Millisecond Temporal Resolution. J Magn Reson Imaging 2021; 54:1246-1254. [PMID: 33761166 DOI: 10.1002/jmri.27603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Visualization of aortic valve dynamics is important in diagnosing valvular diseases but is challenging to perform with magnetic resonance imaging (MRI) due to the limited temporal resolution. PURPOSE To develop an MRI technique with sub-millisecond temporal resolution and demonstrate its application in visualizing rapid aortic valve opening and closing in human subjects in comparison with echocardiography and conventional MRI techniques. STUDY TYPE Prospective. POPULATION Twelve healthy subjects. FIELD STRENGTH/SEQUENCE 3 T; gradient-echo-train-based sub-millisecond periodic event encoded imaging (get-SPEEDI) and balanced steady-state free precession (bSSFP). ASSESSMENT Images were acquired using get-SPEEDI with a temporal resolution of 0.6 msec. get-SPEEDI was triggered by an electrocardiogram so that each echo in the gradient echo train corresponded to an image at a specific time point, providing a time-resolved characterization of aortic valve dynamics. For comparison, bSSFP was also employed with 12 msec and 24 msec temporal resolutions, respectively. The durations of the aortic valve rapid opening (Tro ), rapid closing (Trc ), and the maximal aortic valve area (AVA) normalized to height were measured with all three temporal resolutions. M-mode echocardiograms with a temporal resolution of 0.8 msec were obtained for further comparison. STATISTICAL TEST Parameters were compared between the three sequences, together with the echocardiography results, with a Mann-Whitney U test. RESULTS Significantly shorter Tro (mean ± SD: 27.5 ± 6.7 msec) and Trc (43.8 ± 11.6 msec) and larger maximal AVA/height (2.01 ± 0.29 cm2 /m) were measured with get-SPEEDI compared to either bSSFP sequence (Tro of 56.3 ± 18.8 and 63.8 ± 20.2 msec; Trc of 68.2 ± 16.6 and 72.8 ± 18.2 msec; maximal AVA/height of 1.63 ± 0.28 and 1.65 ± 0.32 cm2 /m for 12 msec and 24 msec temporal resolutions, respectively, P < 0.05). In addition, the get-SPEEDI results were more consistent with those measured using echocardiography, especially for Tro (29.0 ± 4.1 msec, P = 0.79) and Trc (41.6 ± 4.3 msec, P = 0.16). DATA CONCLUSION: get-SPEEDI allows for visualization of human aortic valve dynamics and provided values closer to those measured using echocardiography than the bSSFP sequences. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
Collapse
Affiliation(s)
- Zheng Zhong
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kaibao Sun
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Guangyu Dan
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Qingfei Luo
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Afshin Farzaneh-Far
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Meryem Muge Karaman
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xiaohong Joe Zhou
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
8
|
Repanas TI, Papanastasiou CA, Efthimiadis GK, Fragkakis N, Sachpekidis V, Klein RM, Karvounis H, Karamitsos TD. Cardiovascular magnetic resonance as a complementary method to transthoracic echocardiography for aortic valve area estimation in patients with aortic stenosis: A systematic review and meta-analysis. Hellenic J Cardiol 2020; 62:107-111. [PMID: 32535246 DOI: 10.1016/j.hjc.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular heart disease. While two-dimensional transthoracic echocardiography (2D-TTE) is the standard imaging modality for AS assessment, cardiac magnetic resonance (CMR) offers a reliable and reproducible alternative. The aim of this study was to compare AVA measurements as determined by TTE and CMR in patients with AS. METHODS Electronic databases were searched to identify studies comparing TTE continuity equation to CMR planimetry for AVA assessment. A meta-analysis of mean difference was conducted by using the random effects model. Sensitivity analysis was performed after excluding studies reporting AVA indexed to body surface area (BSA). Heterogeneity was assessed with I2. RESULTS A total of 12 studies, encompassing 621 patients, were included in our systematic review. In the pooled analysis, measurements of AVA by CMR planimetry were found to be significantly higher than those calculated by the continuity equation in TTE (pooled mean difference: 0.09, 95% confidence intervals (CI): 0.01, 0.17, and I2: 93%). The results remained significant, albeit with moderate heterogeneity this time, after excluding the analysis measurements of AVA indexed to BSA (pooled mean difference: 0.08, 95% CI: 0.03 to 0.13, and I2 = 61%). CONCLUSIONS CMR planimetry slightly overestimates AVA compared to TTE continuity equation. Although, 2D-TTE should be the primary imaging modality for the estimation of AVA, CMR may be useful when there is discrepancy with the clinical assessment or when TTE results are discordant or difficult to obtain.
Collapse
Affiliation(s)
- Theodoros I Repanas
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Christos A Papanastasiou
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios K Efthimiadis
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragkakis
- 3rd Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Rolf Michael Klein
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros D Karamitsos
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| |
Collapse
|
9
|
Contemporary Imaging of Aortic Stenosis. Heart Lung Circ 2019; 28:1310-1319. [PMID: 31266725 DOI: 10.1016/j.hlc.2019.05.177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/29/2019] [Accepted: 05/17/2019] [Indexed: 12/26/2022]
Abstract
Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries. Transthoracic echocardiography remains the quintessential imaging modality for the non-invasive characterisation of AS due to its widespread availability, superior assessment of flow haemodynamics, and a wealth of prognostic data accumulated over decades of clinical utility and research applications. With expanding technologies and increasing availability of treatment options such as transcatheter aortic valve replacements, in addition to conventional surgical approaches, accurate and precise assessment of AS severity is critical to guide decisions for and timing of interventions. Despite clear guideline echocardiographic parameters demarcating severe AS, discrepancies between transvalvular velocities, gradients, and calculated valve areas are commonly encountered in clinical practice. This often results in diagnostically challenging cases with significant implications. Greater emphasis must be placed on the quality of performance of basic two dimensional (2D) and Doppler measurements (attention to detail ensuring accuracy and precision), incorporating ancillary haemodynamic surrogates, understanding study- or patient-specific confounders, and recognising the role and limitations of stress echocardiography in the subgroups of low-flow low-gradient AS. A multiparametric approach, along with the incorporation of multimodality imaging (cardiac computed tomography or magnetic resonance imaging) in certain scenarios, is now mandatory to avoid incorrect misclassification of severe AS. This is essential to ensure appropriate selection of patients who would most benefit from interventions on the aortic valve to relieve the afterload mismatch resulting from truly severe valvular stenosis.
Collapse
|
10
|
Varshney R, Murphy B, Woolington S, Ghafoory S, Chen S, Robison T, Ahamed J. Inactivation of platelet-derived TGF-β1 attenuates aortic stenosis progression in a robust murine model. Blood Adv 2019; 3:777-788. [PMID: 30846427 PMCID: PMC6418501 DOI: 10.1182/bloodadvances.2018025817] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022] Open
Abstract
Aortic stenosis (AS) is a degenerative heart condition characterized by fibrosis and narrowing of aortic valves (AV), resulting in high wall shear stress (WSS) across valves. AS is associated with high plasma levels of transforming growth factor-β1 (TGF-β1), which can be activated by WSS to induce organ fibrosis, but the cellular source of TGF-β1 is not clear. Here, we show that platelet-derived TGF-β1 plays an important role in AS progression. We first established an aggressive and robust murine model of AS, using the existing Ldlr -/- Apob100/100 (LDLR) breed of mice, and accelerated AS progression by feeding them a high-fat diet (HFD). We then captured very high resolution images of AV movement and thickness and of blood flow velocity across the AV, using a modified ultrasound imaging technique, which revealed early evidence of AS and distinguished different stages of AS progression. More than 90% of LDLR animals developed AS within 6 months of HFD. Scanning electron microscopy and whole-mount immunostaining imaging of AV identified activated platelets physically attached to valvular endothelial cells (VEC) expressing high phosphorylated Smad2 (p-Smad2). To test the contribution of platelet-derived TGF-β1 in AS, we derived LDLR mice lacking platelet TGF-β1 (TGF-β1platelet-KO-LDLR) and showed reduced AS progression and lower p-Smad2 and myofibroblasts in their AV compared with littermate controls fed the HFD for 6 months. Our data suggest that platelet-derived TGF-β1 triggers AS progression by inducing signaling in VEC, and their subsequent transformation into collagen-producing-myofibroblasts. Thus, inhibiting platelet-derived TGF-β1 might attenuate or prevent fibrotic diseases characterized by platelet activation and high WSS, such as AS.
Collapse
Affiliation(s)
- Rohan Varshney
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Brennah Murphy
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Sean Woolington
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Shahrouz Ghafoory
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Tyler Robison
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Jasimuddin Ahamed
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| |
Collapse
|
11
|
Grading of aortic stenosis severity: a head-to-head comparison between cardiac magnetic resonance imaging and echocardiography. Radiol Med 2018; 123:643-654. [PMID: 29730841 DOI: 10.1007/s11547-018-0895-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/20/2018] [Indexed: 12/26/2022]
Abstract
AIM To prospectively evaluate the accuracy of cardiac magnetic resonance (cMR) imaging for the assessment of aortic valve effective orifice area (EOA) by continuity equation and anatomical aortic valve area (AVA) by direct planimetry, as compared with transthoracic (TTE) and transesophageal (TEE) two-dimensional (2D) echocardiography, respectively. METHODS AND RESULTS A total of 31 patients (21 men, 10 women, mean age 69 ± 10 years) with moderate-to-severe aortic stenosis (AS) diagnosed by TTE and scheduled for elective aortic valve replacement, underwent both cMR and TEE. AVA by cMR was obtained from balanced steady-state free-precession cine-images. EOA was computed from phase-contrast MR flow analysis. AVA at cMR (0.93 ± 0.42 cm2) was highly correlated with TEE-derived planimetry (0.92 ± 0.32 cm2) (concordance correlation coefficient, CCC = 0.85). By excluding 11 patients with extensively thickened and heavily calcified cusps, the CCC increased to 0.93. EOA at cMR (0.86 ± 0.30 cm2) showed a strong correlation with TTE-derived EOA (0.78 ± 0.25 cm2) (CCC = 0.82). CONCLUSIONS cMR imaging is an accurate alternative for the grading of AS severity. Its use may be recommended especially in patients with poor transthoracic acoustic windows and/or in case of discordance between 2D echocardiographic parameters.
Collapse
|
12
|
|
13
|
Bhatia N, Dawn B, Siddiqui TS, Stoddard MF. Impact and predictors of noncircular left ventricular outflow tract shapes on estimating aortic stenosis severity by means of continuity equations. Tex Heart Inst J 2015; 42:16-24. [PMID: 25873793 DOI: 10.14503/thij-13-3635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Determining aortic stenosis (AS) severity is clinically important. Calculating aortic valve (AV) area by means of the continuity equation assumes a circular left ventricular outflow tract (LVOT). The full impact of this assumption in calculating AV area is unknown. Predictors of noncircular LVOT shape in patients with AS are undefined. In 109 adult patients with AS who underwent multiplanar transesophageal echocardiography, we calculated AV area by means of the standard continuity method and by a modified method involving planimetric LVOT area. We found 54 circular, 37 horizontal-oval, 8 vertical-oval, and 10 irregular LVOTs. Area derived by direct planimetry correlated better with the modified than the standard continuity method (r=0.89 vs r=0.85; both P=0.0001). Valve areas of patients with mild, moderate, or severe AS by planimetry were more often mischaracterized with use of the standard than modified method (29 vs 18; P <0.0001). Horizontal-oval AV area derived by planimetry (1.28 ± 0.55 cm(2)) was underestimated by the standard method (1.05 ± 0.47 cm(2); P=0.001), but not by the modified method. Congenital AV morphology and low cardiac index were the only multivariate predictors of horizontal-oval shape. Low cardiac index was the only predictor of noncircular shape. More than half our patients with AS had noncircular LVOTs. Using the modified method reduces mischaracterizations of AS severity. Congenital AV morphology and low cardiac index predict horizontal-oval or noncircular shape. These data suggest the value of direct LVOT measurement to calculate AS severity in patients who have congenital AV or a low cardiac index.
Collapse
|
14
|
Picard FA, Garçon P, Chaudeurge A, Simion C, Cador R. [Planimetric measurement of the regurgitant orifice area using tridimensional transoesophageal echocardiography for aortic regurgitation, reproducibility and feasibility]. Ann Cardiol Angeiol (Paris) 2014; 63:293-299. [PMID: 24953201 DOI: 10.1016/j.ancard.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/14/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Aortic regurgitation is mainly evaluated by trans-thoracic echocardiography using multi-parametric qualitative and semi quantitative tools. All those parameters can fail to meet expectations, resulting in an imperfect diagnostic reliability and assessment of aortic regurgitation severity can be challenging. OBJECTIVES We sought to evaluate feasibility and intra- and inter-observer reproducibility of aortic regurgitant orifice area measured by planimetry with tridimensional trans-esophageal echocardiography on patients with at least grade 2/4 aortic regurgitation. PATIENTS AND METHODS Consecutive patients with at least grade 2/4 aortic regurgitation measured by trans-thoracic echocardiography and referred for trans-esophageal echocardiography for any reason were included. Planimetric reconstructions of regurgitant orifice area were studied and reproducibility indexes between senior and junior observers were calculated. RESULTS Twenty-three patients were included in this study. Intra- and inter-observer reproducibility were excellent with an ICC of 0.95 [0.88-0.98], P<0.0001 and 0.91 [0.79-0.96], P<0.0001, respectively. Mean length of the measurement was 6.6±0.9min [CI95% 6.23-7.01]. CONCLUSION Planimetric measurement of the aortic regurgitant orifice using tridimensional trans-esophageal echocardiography seems to be feasible and has great intra- and inter-observer reproducibility. Reconstruction durations were compatible with a daily use. There is a need now to investigate the reliability of this measurement as compared with the reference technique.
Collapse
Affiliation(s)
- F-A Picard
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - P Garçon
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - A Chaudeurge
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - C Simion
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - R Cador
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| |
Collapse
|
15
|
Speiser U, Quick S, Haas D, Youssef A, Waessnig NK, Ibrahim K, Strasser RH, Schoen S. 3-T magnetic resonance for determination of aortic valve area: A comparison to echocardiography. SCAND CARDIOVASC J 2014; 48:176-83. [DOI: 10.3109/14017431.2014.906646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Affiliation(s)
- Neelakantan Saikrishnan
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| | - Gautam Kumar
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| | - Fadi J. Sawaya
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| | - Stamatios Lerakis
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| | - Ajit P. Yoganathan
- From the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, GA (N.S., S.L., A.P.Y.); Emory University, Department of Medicine, Division of Cardiology (G.K., F.J.S., S.L.); and Atlanta VA Medical Center, Department of Medicine, Division of Cardiology, Decatur, GA (G.K.)
| |
Collapse
|
17
|
Barone-Rochette G, Piérard S, Seldrum S, de Meester de Ravenstein C, Melchior J, Maes F, Pouleur AC, Vancraeynest D, Pasquet A, Vanoverschelde JL, Gerber BL. Aortic Valve Area, Stroke Volume, Left Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis Assessed by Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2013; 6:1009-17. [DOI: 10.1161/circimaging.113.000515] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gilles Barone-Rochette
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Sophie Piérard
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Stéphanie Seldrum
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Christophe de Meester de Ravenstein
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Julie Melchior
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Frédéric Maes
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Anne-Catherine Pouleur
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - David Vancraeynest
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Agnes Pasquet
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Jean-Louis Vanoverschelde
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| | - Bernhard L. Gerber
- From the Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Woluwe St. Lambert, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.); and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (G.B.-R., S.P., S.S., C.d.M.d.R., J.M., F.M., A.-C.P., D.V., A.P., J.-L.V., B.L.G.)
| |
Collapse
|
18
|
Bennett CJ, Maleszewski JJ, Araoz PA. CT and MR imaging of the aortic valve: radiologic-pathologic correlation. Radiographics 2013; 32:1399-420. [PMID: 22977027 DOI: 10.1148/rg.325115727] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Valvular disease is estimated to account for as many as 20% of cardiac surgical procedures performed in the United States. It may be congenital in origin or secondary to another disease process. One congenital anomaly, bicuspid aortic valve, is associated with increased incidence of stenosis, regurgitation, endocarditis, and aneurysmal dilatation of the aorta. A bicuspid valve has two cusps instead of the normal three; resultant fusion or poor excursion of the valve leaflets may lead to aortic stenosis, the presence of which is signaled by dephasing jets on magnetic resonance (MR) images. Surgery is generally recommended for patients with severe stenosis who are symptomatic or who have significant ventricular dysfunction; transcatheter aortic valve implantation (TAVI) is an emerging therapeutic option for patients who are not eligible for surgical treatment. Computed tomography (CT) is an essential component of preoperative planning for TAVI; it is used to determine the aortic root dimensions, severity of peripheral vascular disease, and status of the coronary arteries. Aortic regurgitation, which is caused by incompetent closure of the aortic valve, likewise leads to the appearance of jets on MR images. The severity of regurgitation is graded on the basis of valvular morphologic parameters; qualitative assessment of dephasing jets at Doppler ultrasonography; or measurements of the regurgitant fraction, volume, and orifice area. Mild regurgitation is managed conservatively, whereas severe or symptomatic regurgitation usually leads to valve replacement surgery, especially in the presence of substantial left ventricular enlargement or dysfunction. Bacterial endocarditis, although less common than aortic stenosis and regurgitation, is associated with substantial morbidity and mortality. Electrocardiographically gated CT reliably demonstrates infectious vegetations and benign excrescences of 1 cm or more on the valve surface, allowing the assessment of any embolic complications.
Collapse
|
19
|
Evaluation of the aortic and mitral valves with cardiac computed tomography and cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2012; 28 Suppl 2:109-27. [PMID: 23139149 DOI: 10.1007/s10554-012-0144-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
Cardiac computed tomography (CT) produces high-quality anatomical images of the cardiac valves and associated structures. Cardiac magnetic resonance imaging (MRI) provides images of valve morphology, and allows quantitative evaluation of valvular dysfunction and determination of the impact of valvular lesions on cardiovascular structures. Recent studies have demonstrated that cardiac CT and MRI are important adjuncts to echocardiography for the evaluation of aortic and mitral valvular heart diseases (VHDs). Radiologists should be aware of the technical aspects of cardiac CT and MRI that allow comprehensive assessment of aortic and mitral VHDs, as well as the typical imaging features of common and important aortic and mitral VHDs on cardiac CT and MRI.
Collapse
|
20
|
Dimitriou P, Kähäri A, Emilsson K, Thunberg P. Cardiovascular magnetic resonance imaging and transthoracic echocardiography in the assessment of stenotic aortic valve area: a comparative study. Acta Radiol 2012; 53:995-1003. [PMID: 22983258 DOI: 10.1258/ar.2012.120261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Magnetic resonance (MR) imaging and echocardiography both allow assessment of aortic valve stenosis. In MR the aortic valve area (AvA) is measured using planimetry while in transthoracic echocardiography (TTE) AvA is usually calculated by applying the continuity equation. PURPOSE To compare the measured stenotic aortic valve areas using five different MR-acquisition alternatives with the corresponding area values calculated by TTE. MATERIAL AND METHODS The aortic valve was imaged in 14 patients, with diagnosed aortic valve stenosis, using balanced steady state free precession (bSSFP) gradient echo (GE) and phase contrast imaging (PC). Three adjacent slices were planned to encompass the aortic valve and the aortic valve area was measured using planimetry. The two sets of complex valued images generated by the PC sequence formed three kinds of images that could be used for aortic valve area measurements: the magnitude image (PC/Mag), the modulus (PCA/M), and phase difference (PCA/P) between the two complex images, respectively. The valve area from TTE was calculated using the continuity equation. A cut-off of <1.0 cm(2) was used as a criteria for severe stenosis. RESULTS The mean area differences between the different MR acquisitions and TTE method were -0.05 ± 0.37 cm(2) (GE), -0.18 ± 0.46 cm(2) (bSSFP), 0.27 ± 0.43 cm(2) (PC/Mag), 0.15 ± 0.32 cm(2) (PCA/P), and 0.26 ± 0.27 cm(2) (PCA/M). The valve area was significantly overestimated using PCA/M that, in turn, implied a significant underestimation of the aortic valve stenosis severity compared to the assessments using TTE. CONCLUSION The smallest area valve difference between TTE and an MR-acquisition alternative is obtained with gradient echo images. The use of PCA/M leads to significant differences in planimetry measurements of the aortic valve orifice and the gradation of the stenosis severity compared to TTE.
Collapse
Affiliation(s)
| | | | - Kent Emilsson
- Department of Clinical Physiology, Örebro University Hospital
- School of Health and Medical Sciences, Örebro University
| | - Per Thunberg
- School of Health and Medical Sciences, Örebro University
- Department of Medical Physics, Örebro University Hospital, Sweden
| |
Collapse
|
21
|
Defrance C, Bollache E, Kachenoura N, Perdrix L, Hrynchyshyn N, Bruguière E, Redheuil A, Diebold B, Mousseaux E. Evaluation of aortic valve stenosis using cardiovascular magnetic resonance: comparison of an original semiautomated analysis of phase-contrast cardiovascular magnetic resonance with Doppler echocardiography. Circ Cardiovasc Imaging 2012; 5:604-12. [PMID: 22798520 DOI: 10.1161/circimaging.111.971218] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate quantification of aortic valve stenosis (AVS) is needed for relevant management decisions. However, transthoracic Doppler echocardiography (TTE) remains inconclusive in a significant number of patients. Previous studies demonstrated the usefulness of phase-contrast cardiovascular magnetic resonance (PC-CMR) in noninvasive AVS evaluation. We hypothesized that semiautomated analysis of aortic hemodynamics from PC-CMR might provide reproducible and accurate evaluation of aortic valve area (AVA), aortic velocities, and gradients in agreement with TTE. METHODS AND RESULTS We studied 53 AVS patients (AVA(TTE)=0.87±0.44 cm(2)) and 21 controls (AVA(TTE)=2.96±0.59 cm(2)) who had TTE and PC-CMR of aortic valve and left ventricular outflow tract on the same day. PC-CMR data analysis included left ventricular outflow tract and aortic valve segmentation, and extraction of velocities, gradients, and flow rates. Three AVA measures were performed: AVA(CMR1) based on Hakki formula, AVA(CMR2) based on continuity equation, AVA(CMR3) simplified continuity equation=left ventricular outflow tract peak flow rate/aortic peak velocity. Our analysis was reproducible, as reflected by low interoperator variability (<4.56±4.40%). Comparison of PC-CMR and TTE aortic peak velocities and mean gradients resulted in good agreement (r=0.92 with mean bias=-29±62 cm/s and r=0.86 with mean bias=-12±15 mm Hg, respectively). Although good agreement was found between TTE and continuity equation-based CMR-AVA (r>0.94 and mean bias=-0.01±0.38 cm(2) for AVA(CMR2), -0.09±0.28 cm(2) for AVA(CMR3)), AVA(CMR1) values were lower than AVA(TTE) especially for higher AVA (mean bias=-0.45±0.52 cm(2)). Besides, ability of PC-CMR to detect severe AVS, defined by TTE, provided the best results for continuity equation-based methods (accuracy >94%). CONCLUSIONS Our PC-CMR semiautomated AVS evaluation provided reproducible measurements that accurately detected severe AVS and were in good agreement with TTE.
Collapse
Affiliation(s)
- Carine Defrance
- INSERM U678/UPMC Universite Paris 6, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Underestimation of aortic valve area in calcified aortic valve disease: Effects of left ventricular outflow tract ellipticity. Int J Cardiol 2012; 157:347-53. [DOI: 10.1016/j.ijcard.2010.12.071] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/11/2010] [Accepted: 12/20/2010] [Indexed: 11/17/2022]
|
23
|
Comparison of two-dimensional and real-time three-dimensional transesophageal echocardiography in the assessment of aortic valve area. J Cardiol 2012; 59:337-43. [DOI: 10.1016/j.jjcc.2012.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 01/15/2012] [Accepted: 01/20/2012] [Indexed: 11/23/2022]
|
24
|
Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, Fratz S, Gutberlet M, Hoffmann M, Huber A, Hunold P, Klein C, Krombach G, Kreitner KF, Kühne T, Lotz J, Maintz D, Marholdt H, Merkle N, Messroghli D, Miller S, Paetsch I, Radke P, Steen H, Thiele H, Sarikouch S, Fischbach R. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. KARDIOLOGE 2012. [DOI: 10.1007/s12181-012-0417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
25
|
Saikrishnan N, Yap CH, Milligan NC, Vasilyev NV, Yoganathan AP. In vitro characterization of bicuspid aortic valve hemodynamics using particle image velocimetry. Ann Biomed Eng 2012; 40:1760-75. [PMID: 22318396 DOI: 10.1007/s10439-012-0527-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/27/2012] [Indexed: 01/11/2023]
Abstract
The congenital bicuspid aortic valve (BAV) is associated with increased leaflet calcification, ascending aortic dilatation, aortic stenosis (AS) and regurgitation (AR). Although underlying genetic factors have been primarily implicated for these complications, the altered mechanical environment of BAVs could potentially accelerate these pathologies. The objective of the current study is to characterize BAV hemodynamics in an in vitro system. Two BAV models of varying stenosis and jet eccentricity and a trileaflet AV (TAV) were constructed from excised porcine AVs. Particle Image Velocimetry (PIV) experiments were conducted at physiological flow and pressure conditions to characterize fluid velocity fields in the aorta and sinus regions, and ensemble averaged Reynolds shear stress and 2D turbulent kinetic energy were calculated for all models. The dynamics of the BAV and TAV models matched the characteristics of these valves which are observed clinically. The eccentric and stenotic BAV showed the strongest systolic jet (V = 4.2 m/s), which impinged on the aortic wall on the non-fused leaflet side, causing a strong vortex in the non-fused leaflet sinus. The magnitudes of TKE and Reynolds stresses in both BAV models were almost twice as large as comparable values for TAV, and these maximum values were primarily concentrated around the central jet through the valve orifice. The in vitro model described here enables detailed characterization of BAV flow characteristics, which is currently challenging in clinical practice. This model can prove to be useful in studying the effects of altered BAV geometry on fluid dynamics in the valve and ascending aorta. These altered flows can be potentially linked to increased calcific responses from the valve endothelium in stenotic and eccentric BAVs, independent of concomitant genetic factors.
Collapse
Affiliation(s)
- Neelakantan Saikrishnan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
| | | | | | | | | |
Collapse
|
26
|
La Manna A, Sanfilippo A, Capodanno D, Salemi A, Polizzi G, Deste W, Cincotta G, Cadoni A, Marchese A, Figuera M, Ussia GP, Pittalà R, Privitera C, Tamburino C. Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study. J Cardiovasc Magn Reson 2011; 13:82. [PMID: 22202669 PMCID: PMC3271968 DOI: 10.1186/1532-429x-13-82] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 12/27/2011] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Before trans-catheter aortic valve implantation (TAVI), assessment of cardiac function and accurate measurement of the aortic root are key to determine the correct size and type of the prosthesis. The aim of this study was to compare cardiovascular magnetic resonance (CMR) and trans-thoracic echocardiography (TTE) for the assessment of aortic valve measurements and left ventricular function in high-risk elderly patients submitted to TAVI. METHODS Consecutive patients with severe aortic stenosis and contraindications for surgical aortic valve replacement were screened from April 2009 to January 2011 and imaged with TTE and CMR. RESULTS Patients who underwent both TTE and CMR (n = 49) had a mean age of 80.8 ± 4.8 years and a mean logistic EuroSCORE of 14.9 ± 9.3%. There was a good correlation between TTE and CMR in terms of annulus size (R2 = 0.48, p < 0.001), left ventricular outflow tract (LVOT) diameter (R2 = 0.62, p < 0.001) and left ventricular ejection fraction (LVEF) (R2 = 0.47, p < 0.001) and a moderate correlation in terms of aortic valve area (AVA) (R2 = 0.24, p < 0.001). CMR generally tended to report larger values than TTE for all measurements. The Bland-Altman test indicated that the 95% limits of agreement between TTE and CMR ranged from -5.6 mm to + 1.0 mm for annulus size, from -0.45 mm to + 0.25 mm for LVOT, from -0.45 mm2 to + 0.25 mm2 for AVA and from -29.2% to 13.2% for LVEF. CONCLUSIONS In elderly patients candidates to TAVI, CMR represents a viable complement to transthoracic echocardiography.
Collapse
Affiliation(s)
- Alessio La Manna
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Alessandra Sanfilippo
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
- Excellence Through Newest Advances (ETNA) Foundation, (Viale XX Settembre 70), Catania, (95129), Italy
| | - Antonella Salemi
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Gesualdo Polizzi
- Radiology Unit, Vittorio Emanuele Hospital, (via Plebiscito 628), Catania, (95122), Italy
| | - Wanda Deste
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Glauco Cincotta
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Alessandra Cadoni
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Anna Marchese
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Michele Figuera
- Radiology Unit, Vittorio Emanuele Hospital, (via Plebiscito 628), Catania, (95122), Italy
| | - Gian P Ussia
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Rosetta Pittalà
- Radiology Unit, Vittorio Emanuele Hospital, (via Plebiscito 628), Catania, (95122), Italy
| | - Carmelo Privitera
- Radiology Unit, Vittorio Emanuele Hospital, (via Plebiscito 628), Catania, (95122), Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
- Excellence Through Newest Advances (ETNA) Foundation, (Viale XX Settembre 70), Catania, (95129), Italy
| |
Collapse
|
27
|
|
28
|
Delgado V, Ewe S, Ng A, van der Kley F, Marsan N, Schuijf J, Schalij M, Bax J. Multimodality imaging in transcatheter aortic valve implantation: key steps to assess procedural feasibility. EUROINTERVENTION 2010; 6:643-52. [DOI: 10.4244/eijv6i5a107] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
29
|
Suradi H, Byers S, Green-Hess D, Gradus-Pizlo I, Sawada S, Feigenbaum H. Feasibility of Using Real Time “Live 3D” Echocardiography to Visualize the Stenotic Aortic Valve. Echocardiography 2010; 27:1011-20. [DOI: 10.1111/j.1540-8175.2010.01181.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
30
|
Chenot F, Montant P, Goffinet C, Pasquet A, Vancraeynest D, Coche E, Vanoverschelde JL, Gerber BL. Evaluation of Anatomic Valve Opening and Leaflet Morphology in Aortic Valve Bioprosthesis by Using Multidetector CT: Comparison with Transthoracic Echocardiography. Radiology 2010; 255:377-85. [DOI: 10.1148/radiol.0000082294] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
31
|
Flow and Valvular Disease Studied by Cardiovascular Magnetic Resonance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
32
|
Muellerleile K, Baholli L, Groth M, Barmeyer AA, Koopmann K, Ventura R, Koester R, Adam G, Willems S, Lund GK. Interventricular Mechanical Dyssynchrony: Quantification with Velocity-encoded MR Imaging. Radiology 2009; 253:364-71. [DOI: 10.1148/radiol.2532090145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
33
|
Abstract
There are multiple imaging modalities currently available to noninvasively evaluate the heart and coronary arteries. Choosing the most appropriate modality depends on the pertinent clinical question and the underlying patient characteristics. This article provides an overview of the fields of echocardiography, myocardial perfusion imaging, cardiac computed tomography, and cardiac magnetic resonance imaging, with particular attention to specific clinical applications for cardiac surgery patients.
Collapse
|
34
|
|
35
|
Comprehensive assessment of the severity and mechanism of aortic regurgitation using multidetector CT and MR. Eur Radiol 2009; 20:326-36. [DOI: 10.1007/s00330-009-1544-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
|
36
|
Koskenvuo JW, Järvinen V, Pärkkä JP, Kiviniemi TO, Hartiala JJ. Cardiac magnetic resonance imaging in valvular heart disease. Clin Physiol Funct Imaging 2009; 29:229-40. [DOI: 10.1111/j.1475-097x.2009.00865.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Differences in Aortic Valve Area Measured with CT Planimetry and Echocardiography (Continuity Equation) Are Related to Divergent Estimates of Left Ventricular Outflow Tract Area. AJR Am J Roentgenol 2009; 192:1668-73. [DOI: 10.2214/ajr.08.1986] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
38
|
Gibbons RJ, Araoz PA, Williamson EE. The year in cardiac imaging. J Am Coll Cardiol 2009; 53:54-70. [PMID: 19118725 DOI: 10.1016/j.jacc.2008.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Accepted: 09/25/2008] [Indexed: 02/06/2023]
Affiliation(s)
- Raymond J Gibbons
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
| | | | | |
Collapse
|
39
|
|
40
|
Management of Asymptomatic Severe Aortic Stenosis. J Am Coll Cardiol 2008; 52:1279-92. [DOI: 10.1016/j.jacc.2008.07.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 11/23/2022]
|