Aortic annular sizing using a novel 3-dimensional echocardiographic method: use and comparison with cardiac computed...

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.