Abstract 1487 Thoracic aorta diameters in Marfan patients: Evaluation of a novel 3D modified relaxation-enhanced angiography without contrast and triggering (REACT) with transthoracic echocardiography (TTE)

Objective
To compare the measurement of aortic diameters using a novel flow-independent MR angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT) sequence) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients.

Methods
This retrospective, single-center analysis included 46 examinations of 32 Marfan patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinuses of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists (inner-edge, using multiplanar reconstruction) in modified REACT. Intraclass correlation coefficient, Bland-Altman analyses, F-test, and t-test were used to assess agreement between observers and methods.

Results
Interobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC=0.90–0.97) and modified REACT (ICC=0.98–0.99). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.2 ± 3.2 mm vs. 39.6 ± 3.8 mm; p=0.26) and the STJ (35.2 ± 4.5 mm vs. 35.3 ± 4.7 mm; p=0.552). AoA diameters determined by TTE were larger than in modified REACT (34.3 ± 5.3 mm vs. 30.6 ± 5.3 mm; p<0.01).

Conclusions
Both TTE and modified REACT showed a strong correlation at the SV and STJ whereas at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE for proximal diameters, modified REACT represents an attractive method to depict the thoracic aorta MFS patients.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Thoracic aorta diameters in Marfan patients: Evaluation of a novel 3D modified relaxation-enhanced angiography without contrast and triggering (REACT) with transthoracic echocardiography (TTE)
P. von Stein¹, L. Pennig², J. von Stein³, H. Guthoff⁴, K. Weiss⁵, R. Gertz², I. Thürbach¹, A. Bunck², H. ten Freyhaus¹, D. Maintz², S. Baldus³, C. Hohmann¹, C. Gietzen²
¹Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; ²Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln; ³Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln; ⁴Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinikum Köln, Köln; ⁵Philips Healthcare Germany, Hamburg;
Objective To compare the measurement of aortic diameters using a novel flow-independent MR angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT) sequence) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients. Methods This retrospective, single-center analysis included 46 examinations of 32 Marfan patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinuses of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists (inner-edge, using multiplanar reconstruction) in modified REACT. Intraclass correlation coefficient, Bland-Altman analyses, F-test, and t-test were used to assess agreement between observers and methods. Results Interobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC=0.90–0.97) and modified REACT (ICC=0.98–0.99). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.2 ± 3.2 mm vs. 39.6 ± 3.8 mm; p=0.26) and the STJ (35.2 ± 4.5 mm vs. 35.3 ± 4.7 mm; p=0.552). AoA diameters determined by TTE were larger than in modified REACT (34.3 ± 5.3 mm vs. 30.6 ± 5.3 mm; p<0.01). Conclusions Both TTE and modified REACT showed a strong correlation at the SV and STJ whereas at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE for proximal diameters, modified REACT represents an attractive method to depict the thoracic aorta MFS patients.
https://dgk.org/kongress_programme/jt2023/aP1357.html