Abstract
Introduction: Accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (TAVR) procedure. While computed tomography angiography (CTA) is the widely-accepted standard, two-dimensional (2D) and three-dimensional(3D) transesophageal echocardiography (TEE) is commonly performed to measure the size of the aortic valve and to verify appropriate seating of prostheses. Methods: Patients undergoing TAVR between 2013-2015 were examined. 2D- and 3D-TEEmeasurements were compared to CTA taken as standard. Patients were followed for at least one year. The presence and effect of discrepancy (defined as a difference of more than 10%) between CTA and TEE measurements on survival were examined. Results: One hundred eighty-five patients (70 men) were included. 2D- and 3D-TEE measurements underestimated the annulus size by -1.49 and -1.32 mm, respectively. Discrepancies > 10% between TEE and CTA methods in estimating the aortic annulus size were associated with a decrease in post implant survival. The peak pressure gradient across the aortic prosthesis measured one year after the implant was higher in patients with an initial discrepancy between 3D-TEE and CTA measurements. In a multivariate cox-regression model, the discrepancy between CTA and 2D-TEE readings and the smaller size of the aortic annular area were the predictors of long-term survival. Conclusion: Both 2D and 3D-TEE underestimate the aortic annulus measurements compared to CTA, with 2D-TEE being relatively more precise than 3D-TEE technology. The presence of a discrepancy between echocardiographic and CTA measurements of the aortic annulus is associated with a lower survival rate.
Highlights
Accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (TAVR) procedure
This study aimed to examine the discrepancy between 2D-transesophageal echocardiography (TEE) and 3D-TEE with the widely-accepted standard of computed tomography angiography (CTA)
The traced aortic annulus area was 4.45 ± 0.87 cm^2, and the average diameter was calculated at 23.7 ± 2.4 mm by CTA imaging
Summary
Accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (TAVR) procedure. The rapid evolution of transcatheter aortic valve replacement (TAVR) and technology has pushed for likewise evolution in cardiac imaging techniques and interpretation, mainly focusing on the size of the aortic valve annulus. This single measurement has become critical in the proper sizing of prosthetic transcatheter valves. Tsang et al found that cardiac magnetic resonance imaging (CMRI) measurements had the highest accuracy and lowest variability, followed by multi-sliced computed tomographic angiography (CTA).[5] Compared to CMRI technology, the CTA method overestimated and threedimensional (3D) transesophageal echocardiography (TEE) underestimated the annulus area’s actual size. CTA has become the widelyaccepted standard, largely replacing two-dimensional echocardiography (2D-TEE) due to the complex nature of the aortic annulus’ geometry
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