title: Ascending aortic diameters in congenital aortic stenosis: cardiac magnetic resonance versus transthoracic echocardiography.
abstract: OBJECTIVE
  Congenital aortic stenosis (AS) is the most common obstructive left heart lesion in the young adult population and often complicated by aortic dilatation. Our objective was to evaluate accuracy of aortic imaging with transthoracic echocardiography (TTE) compared with cardiac magnetic resonance (CMR).
  
  
  METHODS
  Aortic diameters were measured at 4 levels by CMR and TTE. Agreement and concordance were assessed by Pearson's correlation and Bland-Altman analysis.
  
  
  RESULTS
  Fifty-nine patients (age 33 ± 8 years; 66% male) with congenital AS and a bicuspid aortic valve (BAV) were included. Aortic diameters were generally smaller with TTE than with CMR. The best correlation was found at the level of the sinotubular junction (R(2) = 0.78) with a bias of 1.46 mm (limits of agreement: -5.47 to +8.39 mm). In patients with an aortic aneurysm >40 mm (n = 29) the correlation and agreement between TTE and CMR were found to be less good when compared with patients with normal aortic diameters, especially at the level of the proximal ascending aorta. The correlation and agreement between both imaging modalities were better in patients with type 1 BAV compared with type 2 BAV. Intra- and interobserver variability was smaller with CMR (1.8-5.9%) compared with TTE (6.9-15.0%).
  
  
  CONCLUSIONS
  CMR was found to be superior to TTE for imaging of the aorta in patients with congenital AS, especially at the level of the proximal ascending aorta when an aortic aneurysm is present. Therefore, ideally CMR should be performed at least once to ensure an ascending aortic aneurysm is not missed.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: van der Linde
authors.forename: Alexia
authors.initials: A
authors.lastname: Rossi
authors.forename: Sing C
authors.initials: SC
authors.lastname: Yap
authors.forename: Jackie S
authors.initials: JS
authors.lastname: McGhie
authors.forename: Annemien E
authors.initials: AE
authors.lastname: van den Bosch
authors.forename: Sharon W M
authors.initials: SW
authors.lastname: Kirschbaum
authors.forename: Brunella
authors.initials: B
authors.lastname: Russo
authors.forename: Arie P J
authors.initials: AP
authors.lastname: van Dijk
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
authors.forename: Robert-Jan M
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging* / Q000473:pathology*; D001014:Aortic Aneurysm / Q000175:diagnosis; D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000175:diagnosis*; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D055815:Young Adult