Core Lab Adjudication of the ACURATE neo2 Hemodynamic Performance Using Computed-Tomography-Corrected Left
Ahmed Elkoumy1,2, Andreas Rück3, Won-Keun Kim4
1Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland.
Insights
Accurate hemodynamic assessment of prosthetic heart valves requires 3D-MDCT to correct left ventricular outflow tract (LVOT) measurements, improving prosthesis-patient mismatch diagnosis compared to 2D-TTE alone.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Conventional 2D transthoracic Echocardiography-Doppler (2D-TTE) has limitations in assessing prosthetic heart valve hemodynamics, particularly in measuring the left ventricular outflow tract (LVOT) area, which assumes a circular shape.
- Accurate hemodynamic assessment is crucial for evaluating outcomes after transcatheter aortic valve implantation (TAVI).
- Prosthesis-patient mismatch (PPM) can affect long-term outcomes and is influenced by accurate LVOT area measurement.
Purpose of the Study:
- To compare the accuracy of 2D-TTE versus 3D-MDCT for measuring LVOT area and its impact on hemodynamic parameters and PPM incidence in patients receiving the ACURATE neo2 TAVI device.
- To evaluate the effectiveness of a corrected continuity equation using 3D-LVOT area from MDCT combined with TTE Doppler parameters for improved hemodynamic assessment.
Main Methods:
- A study involving 258 patients with severe aortic stenosis treated with the ACURATE neo2 valve.
- LVOT area and Doppler-derived parameters (EOA, SV) were calculated using post-TAVI 2D-TTE.
- 3D-LVOT area was obtained from pre-procedural MDCT scans to calculate corrected Doppler parameters and compare PPM incidence between 2D-TTE and 3D-MDCT methods.
Main Results:
- 2D-TTE significantly underestimated LVOT area (350.4 mm² vs. 405.22 mm²) and consequently EOA and SV compared to 3D-MDCT.
- PPM incidence was higher with 2D-TTE-based measurements (8.52%) than with 3D-MDCT-corrected measurements (2.32%).
- Significant differences in EOA among ACURATE neo2 valve sizes were observed with MDCT but not with 2D-TTE.
Conclusions:
- Combining 3D-LVOT area from MDCT with TTE Doppler parameters offers a more accurate hemodynamic assessment and PPM diagnosis in TAVI patients.
- The ACURATE neo2 THV demonstrates a large EOA and low PPM incidence when assessed using 3D-corrected LVOT area.
- Further long-term follow-up studies are needed to confirm these findings.
Abstract:
(1) Background: Hemodynamic assessment of prosthetic heart valves using conventional 2D transthoracic Echocardiography-Doppler (2D-TTE) has limitations. Of those, left ventricular outflow tract (LVOT) area measurement is one of the major limitations of the continuity equation, which assumes a circular LVOT. (2) Methods: This study comprised 258 patients with severe aortic stenosis (AS), who were treated with the ACURATE neo2. The LVOT area and its dependent Doppler-derived parameters, including effective orifice area (EOA) and stroke volume (SV), in addition to their indexed values, were calculated from post-TAVI 2D-TTE. In addition, the 3D-LVOT area from pre-procedural MDCT scans was obtained and used to calculate corrected Doppler-derived parameters. The incidence rates of prosthesis patient mismatch (PPM) were compared between the 2D-TTE and MDCT-based methods (3) Results: The main results show that the 2D-TTE measured LVOT is significantly smaller than 3D-MDCT (350.4 ± 62.04 mm2 vs. 405.22 ± 81.32 mm2) (95% Credible interval (CrI) of differences: -55.15, -36.09), which resulted in smaller EOA (2.25 ± 0.59 vs. 2.58 ± 0.63 cm2) (Beta = -0.642 (95%CrI of differences: -0.85, -0.43), and lower SV (73.88 ± 21.41 vs. 84.47 ± 22.66 mL), (Beta = -7.29 (95% CrI: -14.45, -0.14)), respectively. PPM incidence appears more frequent with 2D-TTE- than 3D-MDCT-corrected measurements (based on the EOAi) 8.52% vs. 2.32%, respectively. In addition, significant differences regarding the EOA among the three valve sizes (S, M and L) were seen only with the MDCT, but not on 2D-TTE. (4) Conclusions: The corrected continuity equation by combining the 3D-LVOT area from MDCT with the TTE Doppler parameters might provide a more accurate assessment of hemodynamic parameters and PPM diagnosis in patients treated with TAVI. The ACURATE neo2 THV has a large EOA and low incidence of PPM using the 3D-corrected LVOT area than on 2D-TTE. These findings need further confirmation on long-term follow-up and in other studies.
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