Mantini Cesare, Khanji Mohammed Y, D'Ugo Emilia, Olivieri Marzia, Caputi Cristiano Giovanni, Bufano Gabriella, Mastrodicasa Domenico, Calvo Garcia Darien, Rotondo Domenico, Candeloro Matteo, Tana Claudio, Cademartiri Filippo, Ionescu Adrian, Caulo Massimo, Gallina Sabina, Ricci Fabrizio
Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Newham University Hospital, Barts Health NHS Trust, London, United Kingdom.
Front Cardiovasc Med. 2021 Oct 18;8:752340. doi: 10.3389/fcvm.2021.752340. eCollection 2021.
Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOA), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOA; (ii) geometric orifice area (GOA) by direct CMR planimetry; (iii) EOA by TTE-continuity equation; and (iv) the "gold standard" multimodality EOA (EOA) obtained by substituting CMR LVOT area into Doppler continuity equation. There was excellent pairwise positive linear correlation among AOA, EOA, GOA, and EOA ( < 0.001); AOA had the highest correlation with EOA ( = 0.985, < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOA and EOA. AOA yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate "one-stop shop" CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.
经胸超声心动图（TTE）是评估主动脉瓣狭窄（AS）的标准技术，推荐使用有效瓣口面积（EOA）对狭窄严重程度进行分级。EOA依赖于操作者，受多种陷阱影响，并且需要多次测量，从而引入了独立的随机误差源。我们测试了别名瓣口面积平面测量法（AOA）的诊断准确性和精确性，AOA是一种通过低流速编码相位对比心血管磁共振（CMR）成像对AS严重程度进行分级的新的、简单的非侵入性技术。连续22例轻度、中度或重度AS患者以及6例年龄和性别匹配的健康对照者在同一天接受了TTE和CMR检查。我们对以下各项之间的一致性和相关性进行了分析：（i）AOA；（ii）通过直接CMR平面测量法得到的几何瓣口面积（GOA）；（iii）通过TTE连续性方程得到的EOA；以及（iv）通过将CMR左心室流出道面积代入多普勒连续性方程得到的“金标准”多模态EOA（EOA）。AOA、EOA、GOA和EOA之间存在极好的两两正线性相关性（<0.001）；AOA与EOA的相关性最高（=0.985，<0.001）。各方法之间具有良好的一致性，AOA与EOA比较时偏差最小（0.019）。AOA产生了极好的观察者内和观察者间可靠性（组内相关系数分别为：0.997和0.998）。二维相位对比成像的别名瓣口面积平面测量法是一种用于AS分级的简单、可重复、准确的CMR“一站式”方法，当超声心动图严重程度评估不确定或不一致时可能有用。需要进行更大规模的研究来证实和验证这些有前景的初步结果。
