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This video is taken from our Cardiac MRI Essentials Course.",{"id":215,"name":216},1,"Course previews",[218,229,234],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},376,{"platform":223,"name":224,"url":225,"size":226},"YouTube","How to assess aortic stenosis using CMR","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=L2bvxAhZR4E",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},14.4,"\u003Cp>In this short video, cardiology mastermind Andrew R. Houghton, MD will take you through the steps to assess aortic stenosis using cardiac MRI (CMR).\u003C\u002Fp>\u003Cp>This video was taken from our CME-accredited Cardiac MRI Essentials course taught by Dr Andrew Houghton—cardiac imaging specialist and head of cardiac imaging at Grantham & District Hospital.\u003C\u002Fp>\u003Cp>Check out the \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fcardiac-mri-essentials\" target=\"_blank\">Cardiac MRI Essentials course \u003C\u002Fa>now!\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},182.66666666666666,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:00:00] \u003C\u002Fb>In this lesson, we're going to learn how to assess aortic stenosis using CMR. Although CMR can play an important role in the assessment of aortic stenosis, echocardiography, nevertheless, remains the cornerstone for this. Echocardiography is widely available, is relatively inexpensive, and provides us with detailed hemodynamic assessment about the aortic valve. Nonetheless, CMR offers us valuable \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:00:30] \u003C\u002Fb>information regarding aortic valve morphology and could be particularly helpful for identifying bicuspid aortic valve, particularly when echo images are suboptimal. Like echocardiography, CMR can provide information not just on valve morphology but also hemodynamic information on flow velocity and therefore, allow the calculation of peak gradient. CMR does provide more accurate information about aortic anatomy, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:01:00] \u003C\u002Fb>left ventricular hypertrophy including the calculation of left ventricular mass and also precise quantification of left ventricular systolic function. So, let's take a look at some examples. Let's begin with the assessment of valve morphology. This is a still frame, from a cine-CMR image. This is a three-chamber view with the left ventricle, here, the mitral valve, and the left atrium, and we have the left ventricular outflow tract, here, we have the aortic \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:01:30] \u003C\u002Fb>valve and the aortic root. And in this view, we can inspect the aortic valve cusps, as in echocardiography in the parasternal long-axis view. We have the right coronary cusp, here, and we have the non-coronary cusp, here. We can assess cusp fitness. In this patient, the cusps are thickened and in the cine image we can also assess cusp mobility, as we'll see in a moment. We can also measure aortic root \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:02:00] \u003C\u002Fb>dimensions and we traditionally do this at the level of the aortic valve annulus, at the level of the sinus of Valsalva, and at the sinotubular junction. So, here's the cine-CMR image, from which that still frame was taken, so we can now see everything in motion. So, we can now assess the mobility of the aortic valve cusps and we can see how those thickened cusps are very restricted in their mobility. We can actually see the \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:02:30] \u003C\u002Fb>forward flow, the ejector flow going through the valve and entering the aorta during systole. We can also look at the left ventricle and we can assess left ventricular size and systolic function. We can also look for any evidence of aortic regurgitation. There's no significant regurgitation present in this particular patient. Here's another view of the aortic valve. This is known as the coronal left \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:03:00] \u003C\u002Fb>ventricular outflow tract or coronal LVOT view. This is a view that's unique to CMR. It doesn't really have an echo equivalent. And in this view, we have the left ventricle, here, we have the aortic valve, just here, again, with thickened cusps. And we have the aortic root and ascending aorta, just here. In using this view, we can again, measure the aortic root dimensions at the level of the aortic annulus,\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:03:30] \u003C\u002Fb>at the sinus of Valsalva, and the sinotubular junction. It should be remembered that the normal values for aortic dimensions are different, depending upon whether we measure them in the three-chamber view that we saw moments ago or whether we measure them in the coronal LVOT view, here. The European Society of Cardiology publishes normal ranges for both sets of views. And here's the cine image, from which that still frame was taken. So again, we have the left ventricle, we have \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:04:00] \u003C\u002Fb>the aortic valve and aortic root, and again, we can appreciate that the aortic valve cusps are thickened, with markedly impaired cusp mobility. And then we have the short-axis view of the aortic valve, where see the aortic valve. The aortic valve in this image is just, here. This is a still frame taken from the cine image and we can see if that's a pseudo bicuspid aortic valve. We have two fused \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:04:30] \u003C\u002Fb>cusps, here, which are joined by median raphe, and then we another cusp, here. In terms of identifying the cusps, we can either look for the origins of the coronary arteries or we can use the interatrial septum, which is just here. And we know that the cusp, which is adjacent to the interatrial septum is the non-coronary cusp. So, the interatrial septum is, here and this cusp is the non-coronary cusp. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:05:00] \u003C\u002Fb>And that makes this the right coronary cusp, towards the patient's right, and this is the left coronary cusp, towards the patient's left. So, non, right and left. We can also see the orifice of this valve. This is a stenosed, pseudo bicuspid aortic valve. And we can also undertake direct planimetry of the orifice to calculate the orifice area. Here is the cine-CMR image, so again, we have the aortic valve \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-efa1ad68-7fff-1540-19f8-e8dbde15b7c6\">[00:05:30] \u003C\u002Fb>seen on [unintelligible 00:05:31]. We have these two fused cusps, with a median raphe in between, and we have the non-coronary cusp, here. And we can see that this pseudo bicuspid aortic valve is significantly stenosed, with a greatly reduced valve orifice area, during systole.\u003C\u002Fp>",{"courses":240,"showAwardsBelow":48},[241],{"id":242,"isFreeCmeCourse":243,"title":244,"type":245,"specialization":246,"teachers":248,"cmeCredits":250,"teacherIllustration":251,"backgroundImage":252,"relativeUrl":253,"lastChanged":254,"created":255,"description":256,"relativeURL":253,"meta":257},1692,false,"Cardiac MRI Essentials","course",[247],"Imaging",[249],"Andrew R. Houghton, MD FRCP",14,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55eac-1fb4-4129-9eb4-dd3bb149bd06","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55eac-ee64-47f2-94b4-37be470cc758","\u002Fcourses\u002Fcardiac-mri-essentials","1767133415","1436124879","Targeted towards internists, cardiologists, and radiologists in training, this course teaches you everything you need to know about cardiac MRI (CMR) from a clinical perspective. You'll learn when to order it and how to assess common conditions, including myocardial ischemia, infarction and viability, common cardiomyopathies, valvular stenosis, regurgitation, and common congenital defects.",{"duration":258,"quizzes":259,"lessons":260},23567,30,85,{"id":262,"name":249,"image":263,"profession":264,"relativeUrl":267,"specializations":268},1590,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef8-716d-4d30-99af-035d10a4581d",{"name":265,"description":266},"Cardiologist","Cardiologist and cardiac imaging specialist at the United Lincolnshire Teaching Hospitals NHS Trust in the UK.","\u002Fteachers\u002Fandrew-r-houghton-md-frcp",[247,269,270,271],"Ultrasound","Cardiology","Infectious diseases",204,"4m",[275,303,321],{"id":276,"title":277,"text":278,"image":279,"author":287,"path":296,"readDuration":297,"readDurationFormatted":298,"internal":299},1352,"Injectable cholesterol medication: using PCSK9 inhibitors","Not all patients reach their LDL targets with oral therapy. Learn when injectable cholesterol medication helps and how PCSK9 inhibitors work.",{"alt":280,"title":281,"size":282,"location":284},"Two PCSK9 inhibitor autoinjector pens—an injectable cholesterol medication—shown on a light blue background.","",{"width":283,"height":283},900,{"bucket":285,"key":286},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC121(3)_magazine image.png",{"id":288,"title":289,"relativeURL":290,"image":291,"professionLong":292,"profession":293,"weight":295},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":294},"Internist",4,"\u002Fmagazine\u002Fpcsk9-injectable-cholesterol-medication",279,"5m",{"created":300,"updated":301,"published":302},1779483663,1779495630,1779495631,{"id":304,"title":305,"text":306,"image":307,"author":313,"path":315,"readDuration":316,"readDurationFormatted":273,"internal":317},1351,"Starting statins as first-line therapy for hyperlipidemia","Starting statins: how to choose the right agent for your patient, match statin intensity to cardiovascular risk, and monitor effectively after initiation.",{"alt":308,"title":281,"size":309,"location":311},"Healthcare provider discussing starting statins with a patient and reviewing a medication bottle",{"width":310,"height":310},660,{"bucket":285,"key":312},"\u002F2026-05\u002FC121(2)_magazine image.png",{"id":288,"title":289,"relativeURL":290,"image":291,"professionLong":292,"profession":314,"weight":295},{"name":294},"\u002Fmagazine\u002Fstarting-statins-first-line-therapy",238,{"created":318,"updated":319,"published":320},1778960150,1779196374,1778961827,{"id":322,"title":323,"text":324,"image":325,"author":331,"path":333,"readDuration":334,"readDurationFormatted":335,"internal":336},1350,"How to recognize INOCA (ANOCA) on an exercise stress test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":326,"title":281,"size":327,"location":329},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).",{"width":328,"height":328},1200,{"bucket":285,"key":330},"\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":288,"title":289,"relativeURL":290,"image":291,"professionLong":292,"profession":332,"weight":295},{"name":294},"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":337,"updated":338,"published":339},1778115738,1778799792,1778118255,{"seo":341,"og":343},{"title":342,"description":213},"Assessing aortic stenosis with the help of cardiac MRI (CMR) | Medmastery",{"title":342,"description":213,"image":344},{"alt":281,"title":281,"size":345,"location":348},{"width":346,"height":347},958,762,{"bucket":285,"key":349},"\u002Fmigrated-images\u002FScreen Shot 2017-10-09 at 2.32.24 PM.png",{"id":351,"created":352,"updated":353,"published":352},150,1507638494,1747923707]