Discrepancies between cardiovascular magnetic resonance and Doppler echocardiography in the measurement of transvalvular gradient in aortic stenosis: the effect of flow vorticity

Journal of Cardiovascular Magnetic Resonance

Éric Larose¹  Philippe Pibarot¹  Lyes Kadem³  Emmanuel Gaillard⁴  Florent Le Ven¹  Romain Capoulade¹  Julio Garcia² 

[1] Québec Heart and Lung Institute, Laval University, Québec, Canada;Department of Radiology, Northwestern University, Chicago, USA;Laboratory of Cardiovascular Fluid Dynamics, Concordia University, Montréal, Canada;Department of Mechanical Engineering, McGill University, Montréal, Canada

关键词: Flow vorticity;    Mean pressure gradient;    Cardiovascular magnetic resonance;    Echo-Doppler;    Aortic stenosis;   

Others  :  828537
DOI  :  10.1186/1532-429X-15-84

 received in 2013-05-06, accepted in 2013-09-03,  发布年份 2013

【 摘 要 】

Background

Valve effective orifice area EOA and transvalvular mean pressure gradient (MPG) are the most frequently used parameters to assess aortic stenosis (AS) severity. However, MPG measured by cardiovascular magnetic resonance (CMR) may differ from the one measured by transthoracic Doppler-echocardiography (TTE). The objectives of this study were: 1) to identify the factors responsible for the MPG measurement discrepancies by CMR versus TTE in AS patients; 2) to investigate the effect of flow vorticity on AS severity assessment by CMR; and 3) to evaluate two models reconciling MPG discrepancies between CMR/TTE measurements.

Methods

Eight healthy subjects and 60 patients with AS underwent TTE and CMR. Strouhal number (St), energy loss (EL), and vorticity were computed from CMR. Two correction models were evaluated: 1) based on the Gorlin equation (MPG_CMR-Gorlin); 2) based on a multivariate regression model (MPG_{CMR-Predicted}).

Results

MPG_CMR underestimated MPG_TTE (bias = −6.5 mmHg, limits of agreement from −18.3 to 5.2 mmHg). On multivariate regression analysis, St (p = 0.002), EL (p = 0.001), and mean systolic vorticity (p < 0.001) were independently associated with larger MPG discrepancies between CMR and TTE. MPG_CMR-Gorlin and MPG_TTE correlation and agreement were r = 0.7; bias = −2.8 mmHg, limits of agreement from −18.4 to 12.9 mmHg. MPG_{CMR-Predicted} model showed better correlation and agreement with MPG_TTE (r = 0.82; bias = 0.5 mmHg, limits of agreement from −9.1 to 10.2 mmHg) than measured MPG_CMR and MPG_CMR-Gorlin.

Conclusion

Flow vorticity is one of the main factors responsible for MPG discrepancies between CMR and TTE.

【 授权许可】

   
2013 Garcia et al.; licensee BioMed Central Ltd.

【 图 表 】

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