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Published on: January 20, 2022
Aortic annular sizing using a novel 3-dimensional echocardiographic method: use and comparison with cardiac computed
Omar K Khalique1, Susheel K Kodali, Jean-Michel Paradis
1Department of Cardiology.
Insights
New 3D transesophageal echocardiography (TEE) analysis closely matches multidetector computed tomography (MDCT) for aortic annulus measurements. Both methods accurately predict paravalvular regurgitation before transcatheter aortic valve replacement.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Echocardiography
Background:
- Cross-sectional 3D transesophageal echocardiography (TEE) measurements often underestimate multidetector row computed tomography (MDCT) for aortic annulus assessment.
- Accurate aortic annulus sizing is critical for successful transcatheter aortic valve replacement (TAVR).
Purpose of the Study:
- To compare aortic annulus measurements obtained from 3D-TEE using a novel software analysis with MDCT.
- To evaluate the ability of both imaging modalities to predict paravalvular regurgitation (PVR) after TAVR.
Main Methods:
- One hundred patients with severe aortic stenosis underwent both contrast-enhanced MDCT and 3D-TEE for pre-TAVR annulus assessment.
- Annulus area, perimeter, and diameters were measured using both techniques.
- Receiver operating characteristic (ROC) analysis was used to assess the prediction of mild or greater PVR.
Main Results:
- 3D-TEE and MDCT measurements of annulus area and perimeter were strongly correlated (r=0.93-0.94, P<0.0001).
- While statistically significant differences existed, they were minimal (≤1%).
- Both MDCT and 3D-TEE demonstrated good discriminatory ability for predicting PVR, with no significant differences between the modalities in ROC analysis.
Conclusions:
- A new method for analyzing 3D-TEE images provides aortic annulus measurements that closely approximate MDCT findings.
- Both 3D-TEE and MDCT accurately predict the occurrence of mild or greater paravalvular regurgitation.
Background:
Previous studies have shown cross-sectional 3-dimensional (3D) transesophageal echocardiographic (TEE) measurements to severely underestimate multidetector row computed tomographic (MDCT) measurements for the assessment of aortic annulus before transcatheter aortic valve replacement. This study compares annulus measurements from 3D-TEE using off-label use of commercially available software with MDCT measurements and assesses their ability to predict paravalvular regurgitation.
Methods And Results:
One hundred patients with severe, symptomatic aortic stenosis who had both contrast MDCT and 3D-TEE for annulus assessment before balloon-expandable transcatheter aortic valve replacement were analyzed. Annulus area, perimeter, and orthogonal maximum and minimum diameters were measured. Receiver operating characteristic analysis was performed with mild or greater paravalvular regurgitation as the classification variable. Three-dimensional TEE and MDCT cross-sectional perimeter and area measurements were strongly correlated (r=0.93-0.94; P<0.0001); however, the small differences (≤1%) were statistically significant (P=0.0002 and 0.0074, respectively). Discriminatory ability for ≥ mild paravalvular regurgitation was good for both MDCT (area under the curve for perimeter and area cover index=0.715 and 0.709, respectively) and 3D-TEE (area under the curve for perimeter and area cover index=0.709 and 0.694, respectively). Differences in receiver operating characteristic analysis between MDCT and 3D-TEE perimeter and area cover indexes were not statistically significant (P=0.15 and 0.35, respectively).
Conclusions:
Annulus measurements using a new method for analyzing 3D-TEE images closely approximate those of MDCT. Annulus measurements from both modalities predict mild or greater paravalvular regurgitation with equivalent accuracy.
