Non-invasive cardiovascular magnetic resonance assessment of pressure recovery distance after aortic valve stenosis

Joao Filipe Fernandes*, Harminder Gill, Amanda Nio, Alessandro Faraci, Valeria Galli, David Marlevi, Malenka Bissell, Hojin Ha, Ronak Rajani, Peter Mortier, Saul G. Myerson, Petter Dyverfeldt, Tino Ebbers, David A. Nordsletten, Pablo Lamata

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Decisions in the management of aortic stenosis are based on the peak pressure drop, captured by Doppler echocardiography, whereas gold standard catheterization measurements assess the net pressure drop but are limited by associated risks. The relationship between these two measurements, peak and net pressure drop, is dictated by the pressure recovery along the ascending aorta which is mainly caused by turbulence energy dissipation. Currently, pressure recovery is considered to occur within the first 40–50 mm distally from the aortic valve, albeit there is inconsistency across interventionist centers on where/how to position the catheter to capture the net pressure drop. Methods: We developed a non-invasive method to assess the pressure recovery distance based on blood flow momentum via 4D Flow cardiovascular magnetic resonance (CMR). Multi-center acquisitions included physical flow phantoms with different stenotic valve configurations to validate this method, first against reference measurements and then against turbulent energy dissipation (respectively n = 8 and n = 28 acquisitions) and to investigate the relationship between peak and net pressure drops. Finally, we explored the potential errors of cardiac catheterisation pressure recordings as a result of neglecting the pressure recovery distance in a clinical bicuspid aortic valve (BAV) cohort of n = 32 patients. Results: In-vitro assessment of pressure recovery distance based on flow momentum achieved an average error of 1.8 ± 8.4 mm when compared to reference pressure sensors in the first phantom workbench. The momentum pressure recovery distance and the turbulent energy dissipation distance showed no statistical difference (mean difference of 2.8 ± 5.4 mm, R2 = 0.93) in the second phantom workbench. A linear correlation was observed between peak and net pressure drops, however, with strong dependences on the valvular morphology. Finally, in the BAV cohort the pressure recovery distance was 78.8 ± 34.3 mm from vena contracta, which is significantly longer than currently accepted in clinical practise (40–50 mm), and 37.5% of patients displayed a pressure recovery distance beyond the end of the ascending aorta. Conclusion: The non-invasive assessment of the distance to pressure recovery is possible by tracking momentum via 4D Flow CMR. Recovery is not always complete at the ascending aorta, and catheterised recordings will overestimate the net pressure drop in those situations. There is a need to re-evaluate the methods that characterise the haemodynamic burden caused by aortic stenosis as currently clinically accepted pressure recovery distance is an underestimation.

Original languageEnglish
Article number5
JournalJournal of Cardiovascular Magnetic Resonance
Issue number1
Early online date30 Jan 2023
Publication statusPublished - Dec 2023


  • 4D Flow MRI
  • Aortic stenosis
  • Flow momentum
  • Non-invasive pressure drop
  • Pressure recovery
  • Turbulence


Dive into the research topics of 'Non-invasive cardiovascular magnetic resonance assessment of pressure recovery distance after aortic valve stenosis'. Together they form a unique fingerprint.

Cite this