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Transaortic flow velocity from dual-source MDCT for the diagnosis of aortic stenosis severity
Carl J Schultz1, Stella-Lida Papadopoulou, Adriaan Moelker
1Department of Cardiology, Erasmus MC Rotterdam, The Netherlands.
Insights
This study introduces a novel method using dual-source multidetector computed tomography (MDCT) to estimate transaortic flow velocity. MDCT peak velocity shows high correlation with transthoracic echocardiography and improves detection of severe aortic stenosis.
Area of Science:
- Cardiovascular imaging
- Medical physics
Background:
- Cardiac multidetector computed tomography (MDCT) captures flow components like volume change and lumenal area.
- Instantaneous flow measurement remains a challenge with current cardiac MDCT techniques.
Purpose of the Study:
- To present a novel method for estimating transaortic flow velocity using multidetector computed tomography (MDCT).
- To evaluate the diagnostic performance of MDCT-derived flow velocity for severe aortic stenosis compared to aortic valve area (AVA) planimetry.
Main Methods:
- Transaortic flow velocity was assessed in 36 patients using both transthoracic echocardiography (TTE) and cardiac MDCT.
- MDCT involved axial imaging of the aortic root, AVA planimetry, and left ventricular volume calculation.
- Flow velocity was computed using incremental ejection volume, duration, and AVA.
Main Results:
- A strong correlation was observed between TTE and MDCT peak velocities (r = 0.75, P < 0.01).
- MDCT peak velocity was significantly higher than TTE peak velocity (median 4.5 vs 4.0, P < 0.01).
- MDCT peak velocity demonstrated superior sensitivity (100%) for diagnosing severe aortic stenosis compared to MDCT AVA (74%) when validated against TTE.
Conclusions:
- Transaortic flow velocity can be reliably estimated using dual-source MDCT.
- MDCT-derived flow velocity offers improved sensitivity for detecting severe aortic stenosis compared to AVA planimetry.
- This method provides a valuable non-invasive tool for assessing aortic stenosis severity.
Objectives:
To describe a method for the estimation of transaortic flow from multidetector computer tomography (MDCT).
Background:
Cardiac MDCT may not allow instantaneous flow measurement yet the components of flow, namely, volume change over time and lumenal area are recorded.
Methods:
In 36 patients, the transaortic flow velocity was determined on transthoracic echocardiography and also with cardiac MDCT as follows: On MDCT an axial orientation through the aortic root was obtained so that the nadir of all three aortic leaflets could be seen simultaneously in one axial image. Aortic valve area (AVA) was determined by planimetry and left ventricular volumes by endocardial border mapping at every 5% increment of the RR intervals. Flow velocity was then calculated as the incremental ejection volume ÷ duration of the increment ÷ AVA.
Results:
The transthoracic echocardiography (TTE) peak velocity and MDCT peak velocity were highly correlated (r = 0.75, P < 0.01). Transaortic peak velocity was higher when measured by MDCT as compared to TTE, with respectively a median [IQ-range] of 4.5 [2.9-5.3] and 4.0 [3.0-4.6], P < 0.01. For the diagnosis of severe aortic stenosis greater concordance with TTE peak velocity was seen with MDCT peak velocity (sensitivity 100%, specificity 76%) than with MDCT AVA (sensitivity 74%, specificity 76%).
Conclusions:
We show for the first time that transaortic flow velocity can be estimated by dual-source MDCT and has a better sensitivity for the detection of severe aortic stenosis than AVA planimetry when compared to the gold standard of TTE peak flow velocity.
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