Meave-González A, Alexanderson E, Hernández-González MA, Siu S, Soto ME, Solorio S, Espínola-Zavaleta N

Language: Spanish
References: 19
Page: 308-312
PDF size: 181.20 Kb.

ABSTRACT

Objective: To evaluate the utility of the cardiovascular magnetic resonance imaging (cMRI) for quantify the aortic area in adult patients with pure aortic stenosis (AS). Method: Comparative cross-sectional study, blinded, in patients with AS, without another valvular pathology associated. A transthoracic echocardiogram (TTE) and cMRI were performed, in all of them. Results were analyzed by Student t test and ji-square, considering significant values p ‹ 0.05. Bayesian analysis and ROC curve, for the determination of the disease severity. Results: No were significant differences with respect to quantification of the speed of transvalvular flow between both methods (TTE 4.593 ± 0.9114 m/s vs cMRI 4.233 ± 0.6894 m/s, p = 0.080), nor the ejection fraction (TTE 54.27 ± 16.451 vs cMRI 48.40 ± 17.332, p = 0.760). The cMRI seems to underestimate the maximum and medium gradients compared with the TTE, in 12.53 mm Hg and 10.07 mm Hg respectively. The sensitivity for the diagnosis of severe aortic stenosis is 90% with specificity 80%.
Conclusions: The cMRI is a useful diagnostic method for the evaluation of patients with pure aortic valve stenosis, as good as TTE. cMRI can to be a diagnostic alternative in cases with limitations to TTE.

REFERENCES

1. Danielsen R, Nordrehaug JE, Stangeland L, Vik-Mo H: Limitations in assessing the severity of aortic stenosis by Doppler gradients. Br Heart J 1988; 59: 551-555.

2. Zhou Q, Faerestrand S, Matre K: Velocity distributions in the left ventricular outflow tract in patients with valvular aortic stenosis. Effect on the measurement of aortic valve area by using the continuity equation. Eur Heart J 1995; 16: 383-393.

3. Burwash IG, Dickinson A, Teskey RJ, Tam JW, Chan KL: Aortic valve area discrepancy by Gorlin equation and Doppler echocardiography continuity equation: relation-ship to flow in patients with valvular aortic stenosis. Can J Cardiol 2000; 16: 985-992.

4. Kim CJ, Berglund H, Nishioka T, Luo H, Siegel RJ: Correspondence of aortic valve area determination from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization. Am Heart J 1996; 132: 1163-1172.

5. Requarth JA: In vitro verification of Doppler prediction of transvalve pressure gradient and orifice area in stenosis. Am J Cardiol 1984; 53(9): 1369-1373.

6. Hanley JA, McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29-36.

7. Otto CM, Pearlman AS: Doppler echocardiography in adults with symptomatic aortic stenosis. Diagnostic utility and cost-effectiveness. Arch Intern Med 1988; 148: 2553-2560.

8. Geibel A, Görnandt L, Kasper W, Bubenheimer P: Reproducibility of Doppler echocardiographic quantification of aortic and mitral valve stenoses: comparison between two echocardiography centers. Am J Cardiol 1991; 67: 1013-1021.

9. Caruthers SD, Lin SJ, Brown P, Mary P, Watkins MP, Williams TA, et al: Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis. Comparison with echocardiography. Circulation 2003; 108: 2236-2243.

10. Skajaerpe T, Hegrenaes L, Hatle L: Noninvasive estimation of valve area in patients with aortic stenosis bay Doppler ultrasound and two-dimensional echocardiography. Circulation 1985; 72: 810-818.

11. C Kupfahl, M Honold, G Mainhardt, H Vogelsberg, A Wagner, H Mahrholdt, U Sechtem: Evaluation of aortic stenosis by cardiovascular magnetic resonance imaging: comparison with established routine clinical techniques. Heart 2004; 90: 893-901.

12. Friedrich MG, Schulz-Menger J, Poetsch T, Pilz B, Uhlich F, Dietz R: Quantification of valvular aortic stenosis by magnetic resonance imaging. Am Heart J 2002; 144: 329-334.

13. Kupari M, Hekali P, Keto P, Poutanen VP, Tikkanen MJ, Standerstkjold-Nordenstm CG: Assessment of aortic valve area in aortic stenosis by magnetic resonance imaging. Am J Cardiol 1992; 70: 952-955.

14. Sondergaard L, Hildebrandt P, Lindvig K, Thomsen C, Sthalberg F, Kassis E, Henriksen O: Valve area and cardiac output in aortic stenosis : quantification by magnetic resonance velocity mapping. Am Heart J 1993; 127: 1156-1164.

15. Kilner PJ, Manzara CC, Mohiaddin RH, Pennell DJ, Sutton MG, Firmin DN, et al: Magnetic resonance jet velocity mapping in mitral and aortic valve stenosis. Circulation 1993; 87: 1239-1248.

16. Caduff JH, Hernández RJ, Ludomirsky A: MR visualization of aortic vegetations. J Comput Assit Tomogr 1996; 20: 613-615.

17. Akins EW, Slone RM, Wiechmann BN, Browning M, Martin TD, Mayfield WR: Perivalvular pseudoaneurysm complicating bacterial endocarditis: MR detection in five cases. Am J Roentgenol 1991; 156: 1155-1158.

18. Sechtem U, Pflugfelder PW, White RD, Gould RG, Holt W, Lipton MJ, Higgins HB: Cine MR imaging: potential for the evaluation of cardiovascular function. Am J Roentgenol 1987; 148: 239-246.

19. Ochiai K, Ishibashi Y, Shimada T, Murakami Y, Inoue S, Sano K: Subendocardial enhancement in gadolinium-diethylene-triamine-pentaacetic acid-enhanced magnetic resonance imaging in aortic stenosis. Am J Cardiol 1999; 83: 1443-1446.