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ToolsGrafton-Clarke, Ciaran, Assadi, Hosamadin, Li, Rui, Mehmood, Zia, Hall, Rimma, Matthews, Gareth, Tsampasian, Vasiliki, Alabed, Samer, Kasmai, Bahman, Staff, Laura, Curtin, John, Yashoda, Gurung-Koney, Sun, Julia, Nair, Sunil, Hewson, David, Thampi, Kurian, Broncano, Jordi, Ricci, Fabrizio, Swoboda, Peter, Swift, Andrew J., Vassiliou, Vassilios S., van der Geest, Rob J. and Garg, Pankaj (2025) Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis. Open Heart, 12 (1). ISSN 2398-595X
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Abstract
Aims Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (V Peak), grading AS severity and predicting AV intervention in a real-world setting. Methods Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included. AS severity was graded using established protocols using three echocardiographic parameters (V Peak, AV area and mean pressure gradient) and CMR-derived V Peak. Results The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V Peak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V Peak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V Peak by CWD was significantly lower to 4D flow with a bias of -0.5 (p=0.01) and a correlation of (R=0.55, p=0.002). The Cox-regression analysis reveals that 4D flow V Peak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V Peak (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ2=9.5, p=0.02). Conclusion 4D flow CMR-derived V Peak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.
| Item Type: | Article |
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| Additional Information: | Data availability statement Data are available upon reasonable request. The data sets generated and analysed during the current study are not publicly available. Access to the raw images of patients is not permitted since specialised postprocessing imaging-based solutions can identify the study patients in the future. Data are available from the corresponding author upon reasonable request. Funding information: PG and AJS are funded by Wellcome Trust Clinical Research Career Development Fellowships (220703/Z/20/Z and 205188/Z/16/Z). For the purpose of Open Access, the authors have applied a CC BY public copyright licence to any author accepted manuscript version arising from this submission. The funders had no role in study design, data collection, analysis, publishing decision or manuscript preparation. |
| Uncontrolled Keywords: | aortic valve stenosis,echocardiography,magnetic resonance imaging,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health |
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| Depositing User: | LivePure Connector |
| Date Deposited: | 02 Jul 2025 08:30 |
| Last Modified: | 14 Jul 2025 12:33 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/99798 |
| DOI: | 10.1136/openhrt-2024-003081 |
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