在主动脉瓣狭窄的诊断中，四维血流相对于超声心动图具有更高的诊断价值。

Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis.

作者信息

Grafton-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, Geest Rob J van der, Garg Pankaj

机构信息

Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.

Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK.

出版信息

Open Heart. 2025 May 7;12(1):e003081. doi: 10.1136/openhrt-2024-003081.

DOI:10.1136/openhrt-2024-003081

PMID:40340893

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12060880/

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), 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, AV area and mean pressure gradient) and CMR-derived V.

RESULTS

The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V 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 significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V (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 assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.

TRIAL REGISTRATION NUMBER

NCT05114785.

摘要

目的

四维血流心血管磁共振成像（4D 流 CMR）已成为评估主动脉瓣狭窄（AS）的一项有前景的技术。本研究旨在评估在现实环境中，4D 流 CMR 与经胸超声心动图（TTE）在估计主动脉瓣（AV）峰值流速（V）、AS 严重程度分级以及预测 AV 干预方面的一致性。

方法

纳入 PREFER-CMR 注册研究中连续接受 TTE 和 4D 流 CMR 检查的参与者。使用既定方案，通过三个超声心动图参数（V、AV 面积和平均压力阶差）以及 CMR 得出的 V 对 AS 严重程度进行分级。

结果

该研究招募了 30 名患者（平均年龄 75.4 岁，67%为男性），其中 17 人接受了 AV 干预。接受 AV 干预的患者中，连续波多普勒（CWD）测得的 V（3.4 对 2.6 m/s，p = 0.0025）和 4D 流测得的 V（4.2 对 2.7 m/s，p < 0.0001）显著更高。CWD 测得的 V 显著低于 4D 流，偏差为 -0.5（p = 0.01），相关性为（R = 0.55，p = 0.002）。Cox 回归分析显示，4D 流测得的 V 显著预测 AV 干预（HR = 2.51，p < 0.01），而 CWD 测得的 V（HR = 0.54，p = 0.76）无显著关联；总体模型拟合显著（χ² = 9.5，p = 0.02）。