John Anna S, Dill Thorsten, Brandt Roland R, Rau Matthias, Ricken Wolfgang, Bachmann Georg, Hamm Christian W
Department of Cardiology, Kerckhoff Clinic, Bad, Nauheim, Germany.
J Am Coll Cardiol. 2003 Aug 6;42(3):519-26. doi: 10.1016/s0735-1097(03)00707-1.
The purpose of the present study was to evaluate whether magnetic resonance (MR) planimetry of the aortic valve area (AVA) may prove to be a reliable, non-invasive diagnostic tool in the assessment of aortic valve stenosis, and how the results compare with current diagnostic standards.
Current standard techniques for assessing the severity of aortic stenosis include transthoracic and transesophageal echocardiography (TEE) as well as transvalvular pressure measurements during cardiac catheterization.
Forty consecutive patients underwent cardiac catheterization, TEE, and MR. The AVA was estimated by direct planimetry (MR, TEE) or calculated indirectly via the peak systolic transvalvular gradient (catheter). Pressure gradients from cardiac catheterization and Doppler echocardiography were also compared.
By MR, the mean AVA(max) was 0.91 +/- 0.25 cm(2); by TEE, AVA(max) was 0.89 +/- 0.28 cm(2); and by catheter, the AVA was calculated as 0.64 +/- 0.26 cm(2). Mean absolute differences in AVA were 0.02 cm(2) for MR versus TEE, 0.27 cm(2) for MR versus catheter, and 0.25 cm(2) for TEE versus catheter. Correlations for AVA(max) were r = 0.96 between MR and TEE, r = 0.47 between TEE and catheter, and r = 0.44 between MR and catheter. The correlation between Doppler and catheter gradients was r = 0.71.
Magnetic resonance planimetry of the AVA correlates well with TEE and less well with the catheter-derived AVA. Invasive and Doppler pressure correlated less well than those obtained from planimetric techniques. Magnetic resonance planimetry of the AVA may provide an accurate, non-invasive, well-tolerated alternative to invasive techniques and transthoracic echocardiography in the assessment of aortic stenosis.
本研究的目的是评估主动脉瓣面积（AVA）的磁共振（MR）平面测量法是否可被证明是评估主动脉瓣狭窄的一种可靠的非侵入性诊断工具，以及其结果与当前诊断标准相比如何。
评估主动脉狭窄严重程度的当前标准技术包括经胸和经食管超声心动图（TEE）以及心导管检查期间的跨瓣压力测量。
连续40例患者接受了心导管检查、TEE和MR检查。通过直接平面测量法（MR、TEE）估计AVA，或通过收缩期峰值跨瓣梯度间接计算（导管检查）。还比较了心导管检查和多普勒超声心动图的压力梯度。
通过MR测量，平均AVA（max）为0.91±0.25cm²；通过TEE测量，AVA（max）为0.89±0.28cm²；通过导管检查计算的AVA为0.64±0.26cm²。AVA的平均绝对差值在MR与TEE之间为0.02cm²，MR与导管检查之间为0.27cm²，TEE与导管检查之间为0.25cm²。AVA（max）的相关性在MR与TEE之间r = 0.96，TEE与导管检查之间r = 0.47，MR与导管检查之间r = 0.44。多普勒和导管梯度之间的相关性r = 0.71。
AVA的磁共振平面测量法与TEE相关性良好，与导管衍生的AVA相关性较差。侵入性和多普勒压力的相关性不如平面测量技术获得的相关性好。AVA的磁共振平面测量法在评估主动脉狭窄方面可能为侵入性技术和经胸超声心动图提供一种准确、非侵入性且耐受性良好的替代方法。
