Philipp Ruile1, Philipp Blanke2, Tobias Krauss3, Stephan Dorfs1, Bernd Jung4, Nikolaus Jander1, Jonathon Leipsic2, Mathias Langer3, Franz-Josef Neumann1, Gregor Pache5. 1. Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany. 2. Center for Heart Valve Innovations, University of British Columbia, St Pauls Hospital, Vancouver, Canada. 3. Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Südring 15, Bad Krozingen 79189, Germany. 4. Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Switzerland. 5. Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Südring 15, Bad Krozingen 79189, Germany gregor.pache@universitaets-herzzentrum.de.
Abstract
AIMS: To evaluate the feasibility of a non-contrast three-dimensional (3D)-FLASH magnetic resonance angiography (MRA) protocol for pre-procedural aortic annulus assessment for transcatheter aortic valve replacement (TAVR) in comparison with cardiac dual-source computed tomography angiography (CTA). METHODS AND RESULTS: In this prospective study, 69 of 104 consecutive patients (mean age 81.8 ± 5.4 years, 37.7% arrhythmic) with severe aortic stenosis who had undergone pre-TAVR cardiac CTA received a respiratory and ECG-triggered, non-contrast 3D-FLASH MRA at 3 T. Annular area measurements were obtained at mid-diastole for both modalities whereas maximum systolic area was assessed by CTA only. Systolic MRA dimensions were modelled, by adding the relative difference of systolic and diastolic CTA area dimensions as a corrective factor. Hypothetical prosthesis sizing was performed based on systolic CTA, diastolic, and modelled systolic MRA area measurements. MR image quality and degree of annular calcifications were evaluated using 4-point-grading scales. The mean acquisition time was 14 ± 4.2 min. The mean image quality was 3.1 ± 0.9 with only two examinations rated non-diagnostic. The mean degree of calcifications was equal. As assessed by Bland-Altman analysis, there was no relevant systematic difference between area measurements for modelled systolic MRA and systolic CTA [the mean difference -3.1 mm(2) (limits of agreement -44.4 mm(2); 38.2 mm(2))]. Agreement for hypothetical prosthesis sizing was found in 63 of 67 (94%) patients for systolic CTA and modelled systolic MRA. CONCLUSION: The employed non-contrast 3D-FLASH MRA protocol allows for reliable assessment of aortic annulus dimensions and calcifications even in the presence of arrhythmias in an all-comers pre-TAVR population. Implementation of this technique appears legitimate in patients at an increased risk for contrast-induced nephropathy. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To evaluate the feasibility of a non-contrast three-dimensional (3D)-FLASH magnetic resonance angiography (MRA) protocol for pre-procedural aortic annulus assessment for transcatheter aortic valve replacement (TAVR) in comparison with cardiac dual-source computed tomography angiography (CTA). METHODS AND RESULTS: In this prospective study, 69 of 104 consecutive patients (mean age 81.8 ± 5.4 years, 37.7% arrhythmic) with severe aortic stenosis who had undergone pre-TAVR cardiac CTA received a respiratory and ECG-triggered, non-contrast 3D-FLASH MRA at 3 T. Annular area measurements were obtained at mid-diastole for both modalities whereas maximum systolic area was assessed by CTA only. Systolic MRA dimensions were modelled, by adding the relative difference of systolic and diastolic CTA area dimensions as a corrective factor. Hypothetical prosthesis sizing was performed based on systolic CTA, diastolic, and modelled systolic MRA area measurements. MR image quality and degree of annular calcifications were evaluated using 4-point-grading scales. The mean acquisition time was 14 ± 4.2 min. The mean image quality was 3.1 ± 0.9 with only two examinations rated non-diagnostic. The mean degree of calcifications was equal. As assessed by Bland-Altman analysis, there was no relevant systematic difference between area measurements for modelled systolic MRA and systolic CTA [the mean difference -3.1 mm(2) (limits of agreement -44.4 mm(2); 38.2 mm(2))]. Agreement for hypothetical prosthesis sizing was found in 63 of 67 (94%) patients for systolic CTA and modelled systolic MRA. CONCLUSION: The employed non-contrast 3D-FLASH MRA protocol allows for reliable assessment of aortic annulus dimensions and calcifications even in the presence of arrhythmias in an all-comers pre-TAVR population. Implementation of this technique appears legitimate in patients at an increased risk for contrast-induced nephropathy. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Kimberly Kallianos; Travis S Henry; Yerem Yeghiazarians; Jeffrey Zimmet; Kendrick A Shunk; Elaine E Tseng; Vaikom Mahadevan; Michael D Hope Journal: Int J Cardiol Date: 2016-12-30 Impact factor: 4.164
Authors: Damiano Caruso; Russell D Rosenberg; Carlo N De Cecco; Stefanie Mangold; Julian L Wichmann; Akos Varga-Szemes; Daniel H Steinberg; Andrea Laghi; U Joseph Schoepf Journal: Curr Cardiol Rep Date: 2016-02 Impact factor: 2.931