Integration of 3D Imaging Data in the Assessment of Aortic Stenosis

O'Brien, Bridget; Schoenhagen, Paul; Kapadia, Samir; Svensson, Lars; Rodriguez, L. Leonardo; Griffin, Brian P.; Tuzcu, E. Murat; Desai, Milind Y.

doi:10.1161/circimaging.111.964916

Cited by 54 publications

(44 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It could also result from underestimation of LVOT due to deviation from circular shape. [17][18][19] We also observed good correlations between SVI estimates by TTE and CMR. Most important, in our study, there were no differences in the degree of underestimation and of deviation from circular shape of LVOT between different AS groups.…”

Section: Pathophysiology and Underlying Mechanisms Of Lg Assupporting

confidence: 65%

“…However, this was questioned by recent 3-dimensional evaluations of LVOT dimensions by both computed tomography and CMR. [17][18][19] In our study, we evaluated whether measurement errors, and in particular underestimation of LVOT diameter or deviation from circular shape, might explain underestimation of both EOA and SVI and thus imitate a false state of LF/LG AS. We observed a relatively good correlation between LVOT area estimates by TTE and direct planimetry by CMR.…”

Section: Pathophysiology and Underlying Mechanisms Of Lg Asmentioning

confidence: 99%

See 1 more Smart Citation

Aortic Valve Area, Stroke Volume, Left Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis Assessed by Cardiac Magnetic Resonance Imaging

Barone-Rochette

Piérard

Seldrum

et al. 2013

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

Background— Recent works using echocardiography suggested that low gradient (LG), low flow (LF) aortic stenosis (AS) has more pronounced left ventricular (LV) concentric remodeling, smaller LV cavity size, and more interstitial fibrosis compared with high gradient (HG) normal flow (NF) AS. Therefore, we evaluated the accuracy of echocardiographic measurements and compared remodeling and fibrosis in different types of AS by cardiac magnetic resonance (CMR). Methods and Results— A total of 128 patients (73±11 years of age; 75 men) with aortic valve area (AVA) <0.6 cm 2 /m 2 and ejection fraction >50% by echocardiography underwent CMR to measure planimetric AVA, phase-contrast indexed stroke volume, LV mass, and focal fibrosis. Using <40 mm Hg and indexed stroke volume <35 mL/m 2 by echocardiography as criteria for LG and LF, 69 (54%) patients were HG/NF, 28 (22%) HG/LF, 17 (13%) LG/NF, and 14 (11%) LG/LF AS. LV outflow tract area, indexed stroke volume, and AVA correlated well between echocardiography and CMR ( r =0.7, 0.61, and 0.65, respectively; P <0.001 for all). By CMR, however, planimetric AVA was larger in LF/LG (0.54±0.08 cm 2 /m 2 ) and LG/NF (0.61±0.08 cm 2 /m 2 ) than in HG/LF (0.46±0.07 cm 2 /m 2 ; P <0.05) AS, and indexed LV mass was lower in LG/LF (75±12 g/m 2 ) and LG/NF (81±18 g/m 2 ) than in HG/LF (100±27 g/m 2 ; P <0.05) AS. All groups of AS had similar LV volumes, predominantly concentric hypertrophy remodeling, and similar amounts of focal fibrosis. Conclusions— CMR confirmed overall accuracy of echocardiographic classification of AS but demonstrated that LG/LF and LG/NF AS have larger AVA, less LV hypertrophy, and similar focal fibrosis compared with HG/LF AS. This challenges the view that LG/LF AS is a more advanced state of AS.

show abstract

Section: Pathophysiology and Underlying Mechanisms Of Lg Assupporting

confidence: 65%

Section: Pathophysiology and Underlying Mechanisms Of Lg Asmentioning

confidence: 99%

Aortic Valve Area, Stroke Volume, Left Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis Assessed by Cardiac Magnetic Resonance Imaging

Barone-Rochette

Piérard

Seldrum

et al. 2013

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

show abstract

“…The functional state of the aortic valve was assessed from qualitative colour Doppler analysis and transvalvular velocity. The Dimensionless Performance Index (DPI) was derived as an accurate method of determining the degree of aortic valve stenosis 13. Peak and mean pressure gradients across the aortic valve were calculated with the modified Bernoulli equation, with continuous-wave Doppler recordings from the highest velocity available.…”

Section: Methodsmentioning

confidence: 99%

Interactions between inflammatory activation and endothelial dysfunction selectively modulate valve disease progression in patients with bicuspid aortic valve

Ali

Chapman

Nguyen

et al. 2014

Heart

View full text Add to dashboard Cite

show abstract

“…The strong correlations between Echo-3D and Echo-2D in our study differ as compared with the observations of Gutierrez-Chico et al, 18 who showed a more modest correlation between the 2 methods. While we are unaware of any other study that has examined the differences in classification using Echo-3D as the reference method in a similar population, O'Brien et al 19 found similar results using computed tomography scanning to determine a 3D LVOT area. Studies in younger patients without AS also have shown that Echo-2D underestimates the LVOT area, 12,20 which may explain the tendency of Echo-2D to estimate a smaller AVA than Echo-3D.…”

Section: Comparison Of Noninvasive Techniquesmentioning

confidence: 76%

Comparison of Invasive and Noninvasive Assessment of Aortic Stenosis Severity in the Elderly

Gertz

Raina

O’Donnell

et al. 2012

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background— Aortic valve area (AVA) in aortic stenosis (AS) can be assessed noninvasively or invasively, typically with similar results. These techniques have not been validated in elderly patients, where common assumptions make them most prone to error. Accurate assessment of AVA is crucial to determine which patients are appropriate candidates for aortic valve replacement. Methods and Results— Fifty elderly patients (mean 86 years, 46% female) referred for cardiac catheterization to evaluate AS also underwent transthoracic echocardiography within 24 hours. To minimize assumptions all patients had 3-dimensional echocardiography (Echo-3D), and at catheterization using directly measured oxygen consumption (Cath-mVo 2 ) and thermodilution cardiac output (Cath-TD). Correlation between Cath-mVo 2 and Echo-3D AVA was poor ( r =0.41). Cath-TD AVA had a moderate correlation with Echo-3D AVA ( r =0.59). Cath-mVo 2 (AVA=0.69 cm 2 ) and Cath-TD (AVA=0.66 cm 2 ) underestimated AVA compared with Echo-3D (AVA=0.76 cm 2; P =0.08 for comparison with Cath-mVo 2 ; P =0.001 for Cath-TD). Compared with Echo-3D, the sensitivity and specificity for determining critical disease (AVA <0.8 cm 2 ) were 81% and 42% for Cath-mVo 2 , and 97% and 53% for Cath-TD. The only independent predictor of the difference between noninvasive and invasive AVA was stroke volume index ( P <0.01). Resistance, a less flow-dependent measure, showed a stronger correlation between Echo-3D and Cath-mVo 2 ( r =0.69), and Echo-3D and Cath-TD ( r =0.77). Conclusions— Standard techniques of AVA assessment for AS show poor correlation in elderly patients, with frequent misclassification of critical AS. Less flow-dependent measures, such as resistance, should be considered to ensure that only appropriate patients are treated with aortic valve replacement.

show abstract

Integration of 3D Imaging Data in the Assessment of Aortic Stenosis

Abstract: Background-In patients with aortic stenosis (AS), precise assessment of severity is critical for treatment decisions.Estimation of aortic valve area (AVA) with transthoracic echocardiographic (TTE)-continuity equation (

Cited by 54 publications

References 29 publications

Aortic Valve Area, Stroke Volume, Left Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis Assessed by Cardiac Magnetic Resonance Imaging

Aortic Valve Area, Stroke Volume, Left Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis Assessed by Cardiac Magnetic Resonance Imaging

Interactions between inflammatory activation and endothelial dysfunction selectively modulate valve disease progression in patients with bicuspid aortic valve

Comparison of Invasive and Noninvasive Assessment of Aortic Stenosis Severity in the Elderly

Contact Info

Product

Resources

About