Becher, Harald

Bull, Sacha

D'Arcy, Joanna

Francis, Jane M

Joseph, Jubin

Karamitsos, Theo D

Myerson, Saul G

Neubauer, Stefan

Pitcher, Alex

Prendergast, Bernard

Suttie, Joseph

English

PubMed

Sacha Bull

Alex Pitcher

Jane M Francis

Joseph Suttie

Jubin Joseph

Joanna D'Arcy

Bernard Prendergast

Harald Becher

Theo D Karamitsos

Stefan Neubauer

Saul G Myerson

Springer - Publisher Connector

CMR improves identification of aortic valve morphology in aortic stenosis

Karamitsos Theo D

Becher Harald

Prendergast Bernard

D'Arcy Joanna

Joseph Jubin

Suttie Joseph

Francis Jane M

Pitcher Alex

Bull Sacha

Neubauer Stefan

Myerson Saul G

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Journal of Cardiovascular Magnetic Resonance

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POSTER PRESENTATION Open Access
CMR improves identification of aortic valve
morphology in aortic stenosis
Sacha Bull*, Alex Pitcher, Jane M Francis, Joseph Suttie, Jubin Joseph, Joanna D’Arcy, Bernard Prendergast,
Harald Becher, Theo D Karamitsos, Stefan Neubauer, Saul G Myerson
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Background
The morphology of the aortic valve is of increasing
importance in the evaluation of patients with calcific
aortic stenosis (AS). The finding of a bicuspid valve can
influence the suitability for transcutaneous aortic valve
implantation, the attention paid to the proximal aorta,
and consideration of family screening. More recent
work has also suggested that the type of bicuspid valve
can provide important information for planning surgery.
Methods
65 patients with moderate-severe calcific AS underwent
routine clinical trans-thoracic echocardiography (Echo)
by an experienced echocardiographer, followed by CMR
at 1.5T. Echo was performed using the parasternal short
axis view through the aortic valve. CMR was performed
in a short axis view through the valve, using SSFP
sequences (linear and radial k-space acquisition) and
analysis undertaken independently by 2 experienced
CMR practitioners. For both imaging modalities, aortic
valve morphology was examined over multiple heart-
beats, in systole and diastole, and classified according to
the Sievers criteria.
Results
Echo identified 13/65 patients with bicuspid valves.
Valve morphology was clearly visualised by CMR in all
subjects, and agreed with all 13 identified as bicuspid by
Echo. However, CMR also identified an additional
11 subjects with bicuspid aortic valves not identified by
Echo (a total of 24/65; p<0.001 vs Echo). The remaining
41 subjects all had clearly tricuspid valves on CMR, and
none of these patients had been incorrectly assigned by
echo. Overall agreement between CMR and Echo was
therefore only moderate (Cohen’s Kappa =0.59).
Valves could be confidently assigned to the correct
Sievers’ classification of aortic valve morphology by
CMR in all 24 cases. 22/24 subjects had type 1 (asym-
metric leaflet size with 1 fused raphe). One subject each
had type 0 (symmetric leaflets with no raphes) and type
2 (2 raphes, or unicuspid valve). Of the type 1 valves,
19/22 had right/left cusp fusion, while the remaining
3 had right/non-coronary cusp fusion patterns.
Conclusions
CMR is a more sensitive method for assessing valve
morphology and determining Sievers classification in
aortic stenosis than trans-thoracic echocardiography.
Echo failed to identify 46% of bicuspid valves (17% of all
valves) when compared to CMR. This may be due to
the limited excursion of valve leaflets in moderate-severe
AS, and the presence of highly echogenic calcifications.
Oxford University, Oxford, UK
Figure 1
Bull et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P332
http://jcmr-online.com/content/13/S1/P332
© 2011 Bull et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
The correct identification of aortic valve morphology
has implications for choice of valve replacement therapy,
management of dilated aortas and family screening.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-P332
Cite this article as: Bull et al.: CMR improves identification of aortic
valve morphology in aortic stenosis. Journal of Cardiovascular Magnetic
Resonance 2011 13(Suppl 1):P332.
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Bull et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P332
http://jcmr-online.com/content/13/S1/P332
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CMR improves identification of aortic valve morphology in aortic stenosis

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