Evaluation of atrial septal defects with 4D flow MRI—multilevel and inter-reader reproducibility for quantification of shunt severity

Chelu, Raluca G.; Horowitz, Michael; Sucha, Dominica; Kardys, Isabella; Ingremeau, Delphine; Vasanawala, Shreyas S.; Nieman, Koen; Paul, Jean‐François; Hsiao, Albert

doi:10.1007/s10334-018-0702-z

Cited by 40 publications

(47 citation statements)

References 14 publications

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“…One of the criteria for intervention in patients with RV volume overload due to atrial septal defect is a Qp:Qs > 1.5:1 . The assessment of Qp:Qs requires either invasive hemodynamic studies or cross‐sectional imaging . This study demonstrates the concept that echocardiography‐derived measurements of QP:QS correlate with invasive hemodynamic assessment.…”

Section: Discussionmentioning

confidence: 71%

“…In disease conditions, the result in isolated RV volume overload, the LV and RV cardiac output becomes discordant, thereby violating the underlying assumptions that allow us to use the values of LV and RV cardiac output interchangeably . As a result of this, the assessment RV cardiac output in disease conditions such as venous or intracardiac left‐to‐right shunt and pulmonary regurgitation requires cross‐sectional imaging or invasive hemodynamic studies . Although these procedures are routinely performed with high safety profile, they lack the advantages of transthoracic echocardiography which include being readily available, easy to operate, no risk to the patient, and lower cost .…”

Section: Discussionmentioning

confidence: 99%

“…14 As a result of this, the assessment RV cardiac output in disease conditions such as venous or intracardiac left-to-right shunt and pulmonary regurgitation requires cross-sectional imaging or invasive hemodynamic studies. 4,5,7 Although these procedures are routinely performed with high safety profile, they lack the advantages of transthoracic echocardiography which include being readily available, easy to operate, no risk to the patient, and lower cost. 15…”

Section: Discussionmentioning

confidence: 99%

“…1-3 As a result, the LV cardiac output cannot be used as surrogate for RV cardiac output in such disease conditions. 4,5 Echocardiography is not currently used for the assessment of RV cardiac output in the setting of left-to-right shunt because of limited data about the feasibility of measuring RV stroke volume by echocardiography. 1-3 Other imaging modalities such as cardiac magnetic resonance imaging and cardiac computed tomography scan are used to assess RV stroke volume and cardiac output in such situations.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Unlike Doppler echocardiography, these cross-sectional imaging modalities are not readily available and do have some other limitations. 4,5 We hypothesized that Doppler-derived cardiac output measurements correlated with Fick-derived cardiac output measurements. The purpose of this study was to determine if Doppler-derived cardiac output measurements correlated with Fick-derived cardiac output (gold standard) measurements.…”

Section: Introductionmentioning

confidence: 99%

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Role of Doppler echocardiography for assessing right ventricular cardiac output in patients with atrial septal defect

Yogeswaran

Kanade

Mejía

et al. 2019

Congenital Heart Disease

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Background Although Doppler echocardiography is routinely used to assess left ventricle cardiac output, there are limited data about the feasibility of Doppler echocardiography for right ventricular (RV) cardiac output assessment in patients with left‐to‐right shunt. The purpose of the study was to determine the correlation between Doppler‐derived and Fick‐derived RV cardiac index (CI), and the interobserver correlation in Doppler‐derived RV CI assessment. Methods Retrospective study of patients (age ≥18 years) with unrepaired atrial septal defect who underwent cardiac catheterization and echocardiography (within 3 days), 2004‐2017. RV CI was calculated using the hydraulic orifice formula: [.785 × (right ventricle outflow tract diameter)2 × right ventricular outflow tract (RVOT) time velocity integral × heart rate]/body surface area. Results A total of 128 patients (age 52 ± 17 years; female 88 [69%]) met the inclusion criteria. There was a modest correlation between Doppler‐derived and Fick‐derived RV CI (r = .57, P < .001), and the mean difference between Doppler‐derived and Fick‐derived RV CI was −.3 (95% confidence interval of agreement, −.8 to +.9) L/min/m2. There was also a modest correlation between Doppler‐derived RV CI from observer #1 and observer #2 (r = .62, P < .001), and the mean difference between Doppler‐derived RV CI from observer #1 and observer #2 was −.2 (95% confidence interval of agreement, −.9 to +.6). Conclusions The current study demonstrated a modest correlation between Doppler‐derived and Fick‐derived RV cardiac output, and a modest interobserver correlation in Doppler‐derived RV cardiac output assessment. Further studies are required to validate these results and to explore other potential applications such as in patients with chronic pulmonary regurgitation.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of Doppler echocardiography for assessing right ventricular cardiac output in patients with atrial septal defect

Yogeswaran

Kanade

Mejía

et al. 2019

Congenital Heart Disease

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Evaluation of Cardiac Shunts With 4D Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability

Ulloa

Vázquez

Vega

et al. 2020

Magnetic Resonance Imaging

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Background In the last decade, the capacity of magnetic resonance (MR) to evaluate congenital anomalies has improved substantially. To date, only a few studies have evaluated the value of 4D‐flow MRI in shunt assessments. Purpose/Hypothesis To assess the intra‐ and interobserver variability of 4D‐flow MRI in patients diagnosed with cardiac/extracardiac shunt. Secondarily, to assess the feasibility of directly measuring the shunt and to determine the prognostic correlation with the pulmonary‐to‐systemic (Qp/Qs) flow ratio. Study Type Retrospective. Population In all, 18 patients with cardiac shunt diagnosis. Field Strength/Sequence 1.5 T/4D phase‐contrast MRI. Assessment Pulmonary and systemic flows were measured at different locations to assess the internal consistency by two observers (twice by one, and once by the other). The Qp/Qs ratio was calculated. When feasible, direct flow was quantified by planimetry. Statistical Tests Spearman's rho correlation coefficient was used to assess the relationship between pulmonary/systemic flows measured at different levels and to compare the jet characteristics with prognostic data as right ventricle volume. Intra‐ and interobserver variability were determined by Bland–Altman plots and interobserver correlation. Results The most common shunt type (n = 10; 55.5%) was ostium secundum atrial septal defect (ASD). Direct visualization and quantification of shunt flow was possible in all studies. Pulmonary and systemic flows showed a strong correlation between these measures (Spearman's rho [r] of 0.872 and 0.899). The mean Qp/Qs ratio was 1.61(0.62). Mean flow rate was 2.01(1.68) l/min. The mean jet diameter was 11.88 (5.44) mm. Intraobserver (r = 0.97) and interobserver correlation (ICC = 0.95) for the Qp/Qs calculation were both excellent. Direct measurement of flow was strongly correlated (r = 0.98; ICC = 0.95). Correlation was strong between Qp/Qs and direct jet flow (r = 0.76 and 0.77), Qp/Qs and mean jet diameter (r = 0.79 and 0.94), and Qp/Qs with jet area (r = 0.77 and 0.94). Data Conclusion Measurement of the Qp/Qs ratio and direct shunt quantification using 4D‐flow MRI was feasible, and highly reproducible. Internal consistency was excellent, with low intra‐ and interobserver variability. Correlation between the Qp/Qs ratio, direct flow measurement, mean diameter, and jet area was strong. Evidence Level 3 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2020;52:1055–1063.

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Editorial for “Evaluation of Cardiac Shunts With 4D Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability”

Westenberg

Roest

Lamb

2020

Magnetic Resonance Imaging

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Evaluation of atrial septal defects with 4D flow MRI—multilevel and inter-reader reproducibility for quantification of shunt severity

Abstract: Blood flow and shunt quantification measured at multiple levels and performed by different readers are reproducible and consistent with 4D flow MRI.

Cited by 40 publications

References 14 publications

Role of Doppler echocardiography for assessing right ventricular cardiac output in patients with atrial septal defect

Role of Doppler echocardiography for assessing right ventricular cardiac output in patients with atrial septal defect

Evaluation of Cardiac Shunts With 4D Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability

Editorial for “Evaluation of Cardiac Shunts With 4D Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability”

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