biostudies-literatureGrafton-Clarke CWellcome Truste003081https://www.ebi.ac.uk/biostudies/studies/S-EPMC12060880biostudies-literatureUnknown12(1)<h4>Aims</h4>Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (V_Peak), grading AS severity and predicting AV intervention in a real-world setting.<h4>Methods</h4>Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included. AS severity was graded using established protocols using three echocardiographic parameters (V_Peak, AV area and mean pressure gradient) and CMR-derived V_Peak.<h4>Results</h4>The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V_Peak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V_Peak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V_Peak by CWD was significantly lower to 4D flow with a bias of -0.5 (p=0.01) and a correlation of (R=0.55, p=0.002). The Cox-regression analysis reveals that 4D flow V_Peak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V_Peak (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ²=9.5, p=0.02).<h4>Conclusion</h4>4D flow CMR-derived V_Peak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.<h4>Trial registration number</h4>NCT05114785.Open heartFour-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis.PMC12060880205188/Z/16/Z220703/Z/20/ZThampi KMehmood ZTsampasian VKasmai BCurtin JYashoda GKBroncano JLi RMatthews GGarg PHall RNair SSwoboda PSwift AJVassiliou VSGeest RJVAssadi HStaff LGrafton-Clarke CRicci FAlabed SSun JHewson DfalseFour-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis.<h4>Aims</h4>Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (V_Peak), grading AS severity and predicting AV intervention in a real-world setting.<h4>Methods</h4>Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included. AS severity was graded using established protocols using three echocardiographic parameters (V_Peak, AV area and mean pressure gradient) and CMR-derived V_Peak.<h4>Results</h4>The study recruited 30 patients (mean age 75.4 years, 67% male), with 17 undergoing AV intervention. Continuous wave Doppler (CWD) V_Peak (3.4 vs 2.6 m/s, p=0.0025) and 4D flow V_Peak (4.2 vs 2.7 m/s, p<0.0001) were significantly higher in patients going for AV intervention. V_Peak by CWD was significantly lower to 4D flow with a bias of -0.5 (p=0.01) and a correlation of (R=0.55, p=0.002). The Cox-regression analysis reveals that 4D flow V_Peak significantly predicts AV intervention (HR=2.51, p<0.01), while CWD V_Peak (HR=0.54, p=0.76) shows no significant association; overall model fit is significant (χ²=9.5, p=0.02).<h4>Conclusion</h4>4D flow CMR-derived V_Peak assessment is superior to echocardiographic CWD assessment for predicting timing of AV intervention.<h4>Trial registration number</h4>NCT05114785.2025-01-01T00:00:00Z2025 May2026-06-02T21:01:32.278Z2026-04-20T03:14:20.475ZS-EPMC120608804034089310.1136/openhrt-2024-003081