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(Circulation. 2005;111:622-628.)
© 2005 American Heart Association, Inc.

Imaging

Magnetic Resonance Imaging Predictors of Coarctation Severity

James C. Nielsen, MD; Andrew J. Powell, MD; Kimberlee Gauvreau, ScD; Edward N. Marcus, MSc; Ashwin Prakash, MD; Tal Geva, MD

From the Department of Cardiology, Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass.

Correspondence to Tal Geva, MD, Department of Cardiology, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail tal.geva{at}cardio.chboston.org

Received June 3, 2004; revision received October 19, 2004; accepted October 21, 2004.

Background— MRI is increasingly used for anatomic assessment of aortic coarctation (CoA), but its ability to predict the transcatheter pressure gradient, considered the reference standard for hemodynamic severity, has not been studied in detail. This study evaluated the ability of MRI to distinguish between mild versus moderate and severe CoA as determined by cardiac catheterization.

Methods and Results— The clinical, MRI, and catheterization data of 31 subjects referred for assessment of native or recurrent CoA were reviewed retrospectively. Patients were divided into 2 groups on the basis of peak coarctation gradient by catheterization: <20 mm Hg (n=12) and 20 mm Hg (n=19). Patients with cardiac index <2.2 L · min^–1 · m^–2 by catheterization were excluded. By logistic regression analysis, the following variables simultaneously predicted coarctation gradient 20 mm Hg: (1) smallest aortic cross-sectional area (adjusted for body surface area) measured by planimetry from gadolinium-enhanced 3D magnetic resonance angiography (OR 1.71 for 10 mm²/m² decrease, P=0.005) and (2) heart rate–corrected mean flow deceleration in the descending aorta measured by phase-velocity cine MRI (OR 1.68 for 100 mL/s^1.5 increase, P=0.018). For the combination of these variables, a predicted probability >0.38 had 95% sensitivity, 82% specificity, 90% positive and negative predictive values, and an area under the receiver-operator characteristics curve of 0.938. In a subsequent validation study, the prediction model correctly classified 9 of 10 patients, with no false-negatives.

Conclusions— The combination of anatomic and flow data obtained by MRI provides a sensitive and specific test for predicting catheterization gradient 20 mm Hg.

Key Words: heart defects, congenital • heart diseases • magnetic resonance imaging • hemodynamics

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