Introduction
Methods
Study population
CMR protocol
CMR analysis
Phantom accuracy
Statistics
Results
Phantom accuracy and study population
CMR-1 (n = 76) | CMR-2 (n = 48) | CMR-3 (n = 51) | Overall (n = 175) | |
---|---|---|---|---|
Age | 31 (25–42) | 30 (20–40) | 15 (11–21) | 28 (17–38) |
Age < 18 years | 4 (5%) | 5 (10%) | 35 (69%) | 44 (25%) |
Range | 12–68 | 16–66 | 5–64 | 5–68 |
Male | 41 (54%) | 32 (67%) | 29 (57%) | 102 (58%) |
Weight (kg) | 76 (65–86) | 70 (56–80) | 55 (40–70) | 69 (55–81) |
Height (cm) | 174 (165–182) | 174 (164–182) | 162 (150–175) | 172 (159–180) |
Body surface area (BSA) (m2) | 1.9 (1.7–2.1) | 1.8 (1.6–2.0) | 1.5 (1.3–1.9) | 1.8 (1.6–2.0) |
Heart rate (beats/min) | 68 ± 12 | 71 ± 12 | 72 ± 13 | 70 ± 13 |
Diagnosis | ||||
Tetralogy of Fallot, PA + VSD | 20 (26%) | 15 (31%) | 25 (49%) | 60 (34%) |
ASD | 2 (3%) | 1 (2%) | 5 (10%) | 8 (5%) |
VSD | 0 (0%) | 4 (8%) | 5 (10%) | 9 (5%) |
TGA | 6 (8%) | 5 (10%) | 2 (4%) | 13 (7%) |
Valvular disease | 28 (37%) | 12 (25%) | 12 (24%) | 52 (30%) |
Turner syndrome | 7 (9%) | 5 (10%) | 0 (0%) | 12 (7%) |
Other | 4 (5%) | 5 (10%) | 2 (4%) | 11 (6%) |
Healthy volunteer | 9 (12%) | 1 (2%) | 0 (0%) | 10 (6%) |
Cardiac morphology & function | ||||
Shunt lesions | 1 (1%) | 3 (6%) | 3 (6%) | 7 (4%) |
LV ejection fraction (%)a | 55 (51–59) | 55 (47–61) | 57 (52–64) | 55 (50–61) |
LV end-diastolic volume (ml)a | 155 (130–200) | 164 (142–199) | 144 (102–177) | 155 (124–194) |
LV end-systolic volume (ml)a | 72 (57–89) | 76 (58–100) | 59 (40–86) | 71 (53–89) |
RV ejection fraction (%)a | 52 (47–57) | 52 (45–56) | 53 (48–59) | 52 (47–57) |
RV end-diastolic volume (ml)a | 190 (155–231) | 216 (174–279) | 170 (131–234) | 192 (150–248) |
RV end-systolic volume (ml)a | 93 (67–120) | 107 (79–137) | 79 (54–117) | 95 (63–123) |
Aortic valve | ||||
Regurgitation | 9 (12%) | 8 (17%) | 3 (6%) | 20 (11%) |
Stenosis | 2 (3%) | 2 (4%) | 0 (0%) | 4 (2%) |
Bicuspid | 14 (18%) | 3 (6%) | 2 (4%) | 19 (11%) |
Biological valve | 4 (5%) | 0 (0%) | 0 (0%) | 4 (2%) |
Pulmonary valve | ||||
Regurgitation | 25 (33%) | 21 (45%) | 23 (48%) | 69 (40%) |
Stenosis | 6 (8%) | 3 (6%) | 2 (4%) | 11 (6%) |
Biological valve | 10 (13%) | 6 (13%) | 7 (15%) | 23 (13%) |
Vessel size | ||||
Aorta (cm2) | 5.5 (4.3–7.7) | 5.9 (4.7–9.0) | 4.7 (3.8–6.1) | 5.3 (4.3–7.6) |
Main pulmonary artery (cm2) | 6.2 (4.9–7.3) | 5.8 (4.7–7.5) | 4.9 (4.0–5.8) | 5.6 (4.5–7.2) |
Velocity offset
No correction | Optimized ST correction | 1st order correction | 2nd order correction | 3rd order correction | P-value῀ no vs. opt. | P-value ‡ no vs. 1st | P-value ‖ no vs. 2nd | P-value $ no vs 3rd | |
---|---|---|---|---|---|---|---|---|---|
Medis QFlow | |||||||||
Net flow (ml/m2)a | 48 ± 13 | – | 47 ± 13 | – | – | – | – | – | – |
Velocity offset (cm/s) | 0.0 ± 2.0 | – | − 0.5 ± 1.8 | – | – | – | < 0.001 | – | – |
Absolute velocity offset (cm/s) | 1.0 ± 1.7 | – | 1.3 ± 1.2 | – | – | – | < 0.001 | – | – |
Difference in net flow with phantom correction (%)b | |||||||||
Difference | 0.2 ± 15.4 | – | −3.2 ± 12.8 | – | – | – | < 0.001 | – | – |
Absolute difference | 3.3 (1.2 to 7.3) | – | 6.1 (3.0 to 11.2) | – | – | – | < 0.001 | – | – |
Range of difference | − 78 to 155 | – | −66 to 74 | – | – | – | – | – | – |
Clinically significant differences (> 10%) | 65 (19%) | – | 103 (30%) | – | – | – | < 0.001 | – | – |
MASS | |||||||||
Net flow (ml/m2)a | 48 ± 13 | 48 ± 12 | 47 ± 13 | 49 ± 13 | 48 ± 12 | – | – | – | – |
Velocity offset (cm/s) | 0.1 ± 2.0 | 0.0 ± 1.5 | −0.3 ± 1.8 | 0.3 ± 1.6 | 0.3 ± 1.6 | 0.247 | < 0.001 | 0.082 | 0.276 |
Absolute velocity offset (cm/s) | 1.0 ± 1.7 | 0.9 ± 1.2 | 1.3 ± 1.3 | 1.1 ± 1.2 | 1.1 ± 1.1 | 0.418 | < 0.001 | 0.013 | 0.003 |
Difference in net flow with phantom correction (%)b | |||||||||
Difference | 0.8 ± 15.6 | −0.1 ± 11.1 | −2.0 ± 13.0 | 2.7 ± 13.4 | 1.8 ± 12.2 | 0.379 | < 0.001 | 0.060 | 0.281 |
Absolute difference | 3.2 (1.3 to 7.2) | 3.7 (1.5 to 8.5) | 5.6 (2.4 to 10.4) | 4.3 (1.6 to 9.3) | 4.6 (2.2 to 9.2) | 0.342 | < 0.001 | 0.015 | 0.004 |
Range of difference | −78 to 161 | −35 to 101 | −65 to 69 | −58 to 101 | − 37 to 120 | – | – | – | – |
Clinically significant differences (> 10%) | 62 (18%) | 67 (19%) | 93 (27%) | 74 (21%) | 79 (23%) | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Circle cvi42 | |||||||||
Net flow (ml/m2)a | 47 ± 13 | 47 ± 13 | 45 ± 12 | 47 ± 13 | 47 ± 13 | – | – | – | – |
Velocity offset (cm/s) | 0.0 ± 2.2 | −0.2 ± 2.0 | − 0.7 ± 2.2 | − 0.1 ± 2.1 | − 0.1 ± 2.2 | 0.063 | < 0.001 | 0.607 | 0.566 |
Absolute velocity offset (cm/s) | 1.2 ± 1.9 | 1.4 ± 1.5 | 1.7 ± 1.6 | 1.4 ± 1.6 | 1.5 ± 1.6 | 0.006 | < 0.001 | 0.014 | < 0.001 |
Difference in net flow with phantom correction (%)b | |||||||||
Difference | 0.0 ± 16.0 | −1.8 ± 14.3 | −4.8 ± 15.0 | − 0.5 ± 15.2 | −0.7 ± 15.5 | 0.046 | < 0.001 | 0.640 | 0.563 |
Absolute difference | 4.1 (1.4 to 9.2) | 6.0 (2.2 to 11.9) | 8.0 (4.3 to 13.6) | 5.3 (2.2 to 12.1) | 6.1 (2.2 to 13.2) | 0.005 | < 0.001 | 0.011 | < 0.001 |
Range of difference | −93 to 131 | −62 to 59 | −66 to 59 | − 85 to 71 | −80 to 75 | – | – | – | – |
Clinically significant differences (> 10%) | 80 (23%) | 103 (30%) | 137 (40%) | 107 (31%) | 115 (33%) | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Net flow quantification
Regurgitation fraction
Aortic valve (n = 175) | Pulmonary valve (n = 171) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
≥1 categorya | 1 categoryb | ≥2 categoriesc | Weighted kappa | 95% CI | ≥1 categorya | 1 categoryb | ≥2 categoriesc | Weighted kappa | 95% CI | |
Medis QFlow | ||||||||||
No correction | 21 (12%) | 19 (11%) | 2 (1%) | 0.69 | 0.55–0.83 | 16 (9%) | 15 (9%) | 1 (1%) | 0.92 | 0.88–0.96 |
1st order correction | 36 (21%) | 31 (18%) | 5 (3%) | 0.55 | 0.40–0.69 | 19 (11%) | 18 (11%) | 1 (1%) | 0.90 | 0.86–0.94 |
MASS | ||||||||||
No correction | 21 (12%) | 20 (11%) | 1 (1%) | 0.73 | 0.61–0.85 | 15 (9%) | 14 (8%) | 1 (1%) | 0.92 | 0.88–0.96 |
Optimized ST correction | 22 (13%) | 19 (11%) | 3 (2%) | 0.69 | 0.55–0.83 | 18 (11%) | 18 (11%) | 0 (0%) | 0.91 | 0.88–0.95 |
1st order correction | 28 (16%) | 22 (13%) | 6 (3%) | 0.62 | 0.49–0.76 | 22 (13%) | 22 (13%) | 0 (0%) | 0.89 | 0.85–0.93 |
2nd order correction | 24 (14%) | 19 (11%) | 5 (3%) | 0.60 | 0.43–0.76 | 23 (13%) | 23 (13%) | 0 (0%) | 0.89 | 0.85–0.93 |
3rd order correction | 18 (10%) | 15 (9%) | 3 (2%) | 0.73 | 0.59–0.87 | 23 (13%) | 23 (13%) | 0 (0%) | 0.89 | 0.85–0.93 |
Circle cvi42 | ||||||||||
No correction | 29 (17%) | 27 (15%) | 2 (1%) | 0.64 | 0.51–0.78 | 15 (9%) | 14 (8%) | 1 (1%) | 0.92 | 0.88–0.96 |
Optimized ST correction | 32 (18%) | 27 (15%) | 5 (3%) | 0.61 | 0.48–0.74 | 35 (20%) | 34 (20%) | 1 (1%) | 0.83 | 0.77–0.88 |
1st order correction | 64 (37%) | 55 (31%) | 9 (5%) | 0.41 | 0.28–0.53 | 26 (15%) | 25 (15%) | 1 (1%) | 0.87 | 0.82–0.92 |
2nd order correction | 24 (14%) | 20 (11%) | 4 (2%) | 0.65 | 0.51–0.79 | 34 (20%) | 32 (19%) | 2 (1%) | 0.83 | 0.77–0.88 |
3rd order correction | 27 (15%) | 23 (13%) | 4 (2%) | 0.63 | 0.50–0.77 | 31 (18%) | 28 (16%) | 3 (2%) | 0.84 | 0.78–0.89 |