OBJECTIVES: This study sought to determine the most reproducible multidetector computed tomography (MDCT) measurements of the aortic annulus and to determine methods to improve the applicability of these measurements for transcatheter aortic valve implantation. BACKGROUND: The reproducibility and applicability of MDCT annular measurements to guide transcatheter aortic valve implantation remain unclear. METHODS: Annular measurements were performed in 50 patients planed for transcatheter aortic valve implantation in multiple planes: basal ring (short- and long-axis, mean diameter, area-derived diameter), coronal, sagittal, and 3-chamber projections. A theoretical model was developed taking into account the differences between the most reproducible MDCT measurements and transesophageal echocardiography to guide valve size choice. RESULTS: The most reproducible measurements were the area-derived diameter and basal ring average diameter (inter-reader intraclass correlation coefficient: 0.87 [95% confidence interval: 0.81 to 0.92] and 0.80 [95% confidence interval: 0.70 to 0.87]; respectively; intrareader >0.90 for all readers). These were generally larger than transesophageal echocardiography diameters (mean difference of 1.5 ± 1.6 mm and 1.1 ± 1.7 mm, respectively). When a strategy of valve-sizing is undertaken using these CT measurements using an echocardiographic sizing scale, a different THV size would be selected in 44% and 40% of cases, respectively. When adjusting the sizing cutoffs to account for the differences in observed diameters, this was reduced to 10% to 12% (p < 0.01 for both, respectively). CONCLUSIONS: The most reproducible MDCT measurements of the annulus are the area-derived diameter and basal ring average diameter, with derived values generally larger than those obtained with echocardiography. If MDCT is used for valve sizing, a strategy incorporating these differences may be important. MDCT using these easily derived measurements may be ideally suited to sizing transcatheter aortic valves as they account for the eccentricity of the aortic annulus, are reproducible, and are noninvasive.
OBJECTIVES: This study sought to determine the most reproducible multidetector computed tomography (MDCT) measurements of the aortic annulus and to determine methods to improve the applicability of these measurements for transcatheter aortic valve implantation. BACKGROUND: The reproducibility and applicability of MDCT annular measurements to guide transcatheter aortic valve implantation remain unclear. METHODS: Annular measurements were performed in 50 patients planed for transcatheter aortic valve implantation in multiple planes: basal ring (short- and long-axis, mean diameter, area-derived diameter), coronal, sagittal, and 3-chamber projections. A theoretical model was developed taking into account the differences between the most reproducible MDCT measurements and transesophageal echocardiography to guide valve size choice. RESULTS: The most reproducible measurements were the area-derived diameter and basal ring average diameter (inter-reader intraclass correlation coefficient: 0.87 [95% confidence interval: 0.81 to 0.92] and 0.80 [95% confidence interval: 0.70 to 0.87]; respectively; intrareader >0.90 for all readers). These were generally larger than transesophageal echocardiography diameters (mean difference of 1.5 ± 1.6 mm and 1.1 ± 1.7 mm, respectively). When a strategy of valve-sizing is undertaken using these CT measurements using an echocardiographic sizing scale, a different THV size would be selected in 44% and 40% of cases, respectively. When adjusting the sizing cutoffs to account for the differences in observed diameters, this was reduced to 10% to 12% (p < 0.01 for both, respectively). CONCLUSIONS: The most reproducible MDCT measurements of the annulus are the area-derived diameter and basal ring average diameter, with derived values generally larger than those obtained with echocardiography. If MDCT is used for valve sizing, a strategy incorporating these differences may be important. MDCT using these easily derived measurements may be ideally suited to sizing transcatheter aortic valves as they account for the eccentricity of the aortic annulus, are reproducible, and are noninvasive.
Authors: Xiaohan Hu; Claudia Frellesen; Ralf W Bauer; J Matthias Kerl; Martin Beeres; Boris Bodelle; Thomas Lehnert; Thomas J Vogl; Julian L Wichmann Journal: Radiol Med Date: 2015-02-03 Impact factor: 3.469
Authors: Borek Foldyna; Camelia Jungert; Christian Luecke; Konstantin von Aspern; Sonja Boehmer-Lasthaus; Eva Maria Rueth; Matthias Grothoff; Stefan Nitzsche; Matthias Gutberlet; Friedrich Wilhelm Mohr; Lukas Lehmkuhl Journal: Int J Cardiovasc Imaging Date: 2015-04-19 Impact factor: 2.357
Authors: Annika Schuhbaeck; Stephan Achenbach; Tobias Pflederer; Mohamed Marwan; Jasmin Schmid; Holger Nef; Johannes Rixe; Franziska Hecker; Christian Schneider; Michael Lell; Michael Uder; Martin Arnold Journal: Eur Radiol Date: 2014-05-22 Impact factor: 5.315