Junyang Lou1, Nancy A Obuchowski2, Amar Krishnaswamy1, Zoran Popovic3, Scott D Flamm3, Samir R Kapadia1, Lars G Svensson1, Michael A Bolen3, Milind Y Desai3, Sandra S Halliburton3, E Murat Tuzcu1, Paul Schoenhagen4. 1. Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. 2. Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. 3. Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA. 4. Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: schoenp1@ccf.org.
Abstract
BACKGROUND: Preprocedural 3-dimensional CT imaging of the aortic annular plane plays a critical role for transcatheter aortic valve replacement (TAVR) planning; however, manual reconstructions are complex. Automated analysis software may improve reproducibility and agreement between readers but is incompletely validated. METHODS: In 110 TAVR patients (mean age, 81 years; 37% female) undergoing preprocedural multidetector CT, automated reconstruction of the aortic annular plane and planimetry of the annulus was performed with a prototype of now commercially available software (syngo.CT Cardiac Function-Valve Pilot; Siemens Healthcare, Erlangen, Germany). Fully automated, semiautomated, and manual annulus measurements were compared. Intrareader and inter-reader agreement, intermodality agreement, and interchangeability were analyzed. Finally, the impact of these measurements on recommended valve size was evaluated. RESULTS: Semiautomated analysis required major correction in 5 patients (4.5%). In the remaining 95.5%, only minor correction was performed. Mean manual annulus area was significantly smaller than fully automated results (P < .001 for both readers) but similar to semiautomated measurements (5.0 vs 5.4 vs 4.9 cm(2), respectively). The frequency of concordant recommendations for valve size increased if manual analysis was replaced with the semiautomated method (60% agreement was improved to 82.4%; 95% confidence interval for the difference [69.1%-83.4%]). CONCLUSIONS: Semiautomated aortic annulus analysis, with minor correction by the user, provides reliable results in the context of TAVR annulus evaluation.
RCT Entities:
BACKGROUND: Preprocedural 3-dimensional CT imaging of the aortic annular plane plays a critical role for transcatheter aortic valve replacement (TAVR) planning; however, manual reconstructions are complex. Automated analysis software may improve reproducibility and agreement between readers but is incompletely validated. METHODS: In 110 TAVR patients (mean age, 81 years; 37% female) undergoing preprocedural multidetector CT, automated reconstruction of the aortic annular plane and planimetry of the annulus was performed with a prototype of now commercially available software (syngo.CT Cardiac Function-Valve Pilot; Siemens Healthcare, Erlangen, Germany). Fully automated, semiautomated, and manual annulus measurements were compared. Intrareader and inter-reader agreement, intermodality agreement, and interchangeability were analyzed. Finally, the impact of these measurements on recommended valve size was evaluated. RESULTS: Semiautomated analysis required major correction in 5 patients (4.5%). In the remaining 95.5%, only minor correction was performed. Mean manual annulus area was significantly smaller than fully automated results (P < .001 for both readers) but similar to semiautomated measurements (5.0 vs 5.4 vs 4.9 cm(2), respectively). The frequency of concordant recommendations for valve size increased if manual analysis was replaced with the semiautomated method (60% agreement was improved to 82.4%; 95% confidence interval for the difference [69.1%-83.4%]). CONCLUSIONS: Semiautomated aortic annulus analysis, with minor correction by the user, provides reliable results in the context of TAVR annulus evaluation.
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