Won-Keun Kim1, Matthias Renker2, Andreas Rolf3, Christoph Liebetrau3, Arnaud Van Linden4, Mani Arsalan4, Mirko Doss4, Julian Rieck5, Maksymilian P Opolski6, Helge Möllmann7, Thomas Walther4, Christian W Hamm3. 1. Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany. Electronic address: w.kim@kerckhoff-klinik.de. 2. Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany. 3. Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany. 4. Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany. 5. Angio Consult, Speyer, Germany. 6. Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland. 7. St. Johannes Hospital, Department of Cardiology, Dortmund, Germany.
Abstract
BACKGROUND: The extent of aortic valve calcification is an important determinant of procedural success in transcatheter aortic valve implantation (TAVI). We sought to validate device landing zone calcium volume (DLZ-CV) measurements on contrast-enhanced multidetector computed tomography (MDCT) with non-contrast-enhanced scans as reference. METHODS: We determined DLZ-CV in 141 patients undergoing transfemoral TAVI. Non-contrast-enhanced images were analyzed using a threshold of 130 HU as reference (DLZ-CV130). For contrast-enhanced scans, we applied various thresholds including 450 HU (DLZ-CV450), 850 HU (DLZ-CV850), mean aortic attenuation (AttenAo) + 2 SD (DLZ-CV2SD), AttenAo + 4 SD (DLZ-CV4SD), AttenAo + 4 SD + 5 mm3 volume filter (DLZ-CV4SD+), and based on visual estimation (DLZ-CVvis). We compared DLZ-CV values between patients with versus without paravalvular leak (PVL), and between patients with versus without post-dilatation stratified by the type of prosthesis. RESULTS: All DLZ-CV measurements on contrast-enhanced scans significantly differed from DLZ-CV130 (p < 0.001 for all comparisons). The best approximation to DLZ-CV130 was achieved with DLZ-CV4SD+ (508 mm3 [332-772]; Pearson correlation: R = 0.87, p < 0.001; Bland-Altman: mean difference 1339 mm3 [limits of agreement 79;2600]). Moreover, DLZ-CV4SD+ allowed for discrimination of PVL ≥1° or the need for post-dilatation in patients receiving self-expanding prostheses. Procedural outcome using balloon-expandable prostheses was independent of DLZ-CV. CONCLUSION: Measurement of DLZ-CV using contrast-enhanced scans with unadjusted thresholds results in incorrect estimation of the calcium volume. The use of a scan-specific individual HU threshold including a volume filter (DLZ-CV4SD+) provides the best approximation to the reference and allows for discrimination of PVL ≥ 1° in patients receiving the Acurate neo prosthesis.
BACKGROUND: The extent of aortic valve calcification is an important determinant of procedural success in transcatheter aortic valve implantation (TAVI). We sought to validate device landing zone calcium volume (DLZ-CV) measurements on contrast-enhanced multidetector computed tomography (MDCT) with non-contrast-enhanced scans as reference. METHODS: We determined DLZ-CV in 141 patients undergoing transfemoral TAVI. Non-contrast-enhanced images were analyzed using a threshold of 130 HU as reference (DLZ-CV130). For contrast-enhanced scans, we applied various thresholds including 450 HU (DLZ-CV450), 850 HU (DLZ-CV850), mean aortic attenuation (AttenAo) + 2 SD (DLZ-CV2SD), AttenAo + 4 SD (DLZ-CV4SD), AttenAo + 4 SD + 5 mm3 volume filter (DLZ-CV4SD+), and based on visual estimation (DLZ-CVvis). We compared DLZ-CV values between patients with versus without paravalvular leak (PVL), and between patients with versus without post-dilatation stratified by the type of prosthesis. RESULTS: All DLZ-CV measurements on contrast-enhanced scans significantly differed from DLZ-CV130 (p < 0.001 for all comparisons). The best approximation to DLZ-CV130 was achieved with DLZ-CV4SD+ (508 mm3 [332-772]; Pearson correlation: R = 0.87, p < 0.001; Bland-Altman: mean difference 1339 mm3 [limits of agreement 79;2600]). Moreover, DLZ-CV4SD+ allowed for discrimination of PVL ≥1° or the need for post-dilatation in patients receiving self-expanding prostheses. Procedural outcome using balloon-expandable prostheses was independent of DLZ-CV. CONCLUSION: Measurement of DLZ-CV using contrast-enhanced scans with unadjusted thresholds results in incorrect estimation of the calcium volume. The use of a scan-specific individual HU threshold including a volume filter (DLZ-CV4SD+) provides the best approximation to the reference and allows for discrimination of PVL ≥ 1° in patients receiving the Acurate neo prosthesis.
Authors: Jonathan M Michel; Antonio H Frangieh; Daniele Giacoppo; Hector A Alvarez-Covarrubias; Costanza Pellegrini; Tobias Rheude; Oliver Deutsch; N Patrick Mayr; P Moritz Rumpf; Barbara E Stähli; Adnan Kastrati; Heribert Schunkert; Erion Xhepa; Michael Joner; A Markus Kasel Journal: Clin Res Cardiol Date: 2021-09-09 Impact factor: 5.460
Authors: Victor Mauri; Thomas Frohn; Florian Deuschl; Kawa Mohemed; Kathrin Kuhr; Andreas Reimann; Maria Isabel Körber; Niklas Schofer; Matti Adam; Kai Friedrichs; Elmar W Kuhn; Smita Scholtz; Volker Rudolph; Thorsten C W Wahlers; Stephan Baldus; Navid Mader; Ulrich Schäfer; Tanja K Rudolph Journal: Open Heart Date: 2020-05