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[Comparison of aortic annular diameter defined by different measurement mordalities before transcatheter aortic valve
1Heart Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
Insights
Multislice computed tomography (MSCT) measurements of aortic annular diameter are larger than those from transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in severe aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI). Comprehensive considerations are crucial for prosthetic valve selection in TAVI.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Severe aortic stenosis necessitates transcatheter aortic valve implantation (TAVI).
- Accurate aortic annular sizing is critical for prosthetic valve selection in TAVI.
Purpose of the Study:
- To compare aortic annular diameter measurements using transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT).
- To evaluate the impact of these measurements on prosthetic valve selection for TAVI.
Main Methods:
- Retrospective analysis of 138 severe aortic stenosis patients referred for TAVI.
- Comparison of aortic annular diameters measured by TTE, TEE, and MSCT.
- Post-TAVI TTE used to assess pre-TAVI measurement accuracy.
Main Results:
- TTE and TEE measurements showed good correlation (r=0.87, P<0.05).
- MSCT measurements (mean of long/short axes, cross-sectional area, circumference) were consistently larger than TTE and TEE (P<0.05).
- Successful TAVI in all patients, with minor paravalvular leakage in 3 and one case of restenosis requiring valve-in-valve.
Conclusions:
- Aortic annular diameters measured by MSCT are larger than those by TTE and TEE in severe aortic stenosis patients undergoing TAVI.
- In the absence of a gold standard, comprehensive assessment is vital for optimal prosthetic valve selection in TAVI.
- Careful consideration of imaging modality differences impacts clinical outcomes in TAVI procedures.
Abstract:
Objective: To compare aortic annular diameter measured by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) in patients with severe aortic stenosis, and to evaluate the impact on selection of prosthetic valve type in transcatheter aortic valve implantation (TAVI). Methods: Clinical data of 138 patients with severe aortic stenosis referred for TAVI between January 2014 and June 2016 in our hospital were retrospectively analyzed.The difference of aortic annular diameter measured by TTE, TEE, and MSCT were compared.TTE was performed after TAVI to evaluate the accuracy of measurement before TAVI. Results: (1) Aortic annular diameter was (23.37±2.22) mm by TTE and (23.52±1.70) mm by TEE (P=0.12). Pearson correlation analysis showed that aortic annular diameter measured by TTE was correlated to that measured by TEE (r=0.87, P<0.05). (2)The long-axis diameter and the short-axis diameter measured by MSCT multiplanar reconstruction were significantly different ((27.86±2.87) mm vs. (21.91±2.53) mm, P<0.05). There was no significant difference between the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT ((24.92±2.38) mm vs. (24.84±2.25) mm, P=0.08). However, the diameter derived from the circumference ((25.35±2.34) mm) was significantly larger than the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT, and the difference were (0.43±0.62) mm and (0.51±0.62) mm respectively(both P<0.05). (3) Measurements of the aortic annulus diameter by MSCT including the mean of the long- and short-axis diameters, diameter derived from cross-sectional area, and diameter derived from the circumference were larger than the measurement by TTE and TTE (all P<0.05). (4) Implantation was successful in all patients.Moderate to severe paravalvular leakage was detected in 3 patients at 7 days post TAVI, and 1 patient developed severe prosthetic valve restenosis at 6 months post TAVI and received valve-in-valve implantation. Conclusions: In severe aortic stenosis patients referred for TAVI, the aortic annular diameter derived from TTE and TEE measurements are smaller than that from MSCT.In the absence of a gold standard, selection of prosthetic valve type in TAVI procedure should rely on comprehensive considerations, which is of importance to get good clinical results for severe aortic stenosis patients underwent TAVI.
