Aortic root evaluation prior to transcatheter aortic valve implantation-Correlation of manual and semi-automatic measurements.

Barbora Horehledova,Babs M F Hendriks,Joachim E Wildberger,Bastiaan L J H Kietselaer,Nienke G Eijsvoogel,Casper Mihl,Chris Schwemmer,Marco Das,Davide Pacini

doi:10.1371/journal.pone.0199732

Barbora Horehledova, Babs M F Hendriks + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0199732

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Journal: PloS one	Publication Date: Jun 28, 2018
Citations: 11	License type: CC BY 4.0

Affiliation: Maastricht University, Siemens Healthcare (Germany)

Abstract

BackgroundPre-procedural TAVI planning requires highly sophisticated and time-consuming manual measurements performed by experienced readers. Semi-automatic software may assist with partial automation of assessment of multiple parameters. The aim of this study was to evaluate differences between manual and semi-automatic measurements in terms of agreement and time.MethodsOne hundred and twenty TAVI candidates referred for the retrospectively ECG-gated CTA (2nd and 3rd generation dual source CT) were evaluated. Fully manual and semi-automatic measurements of fourteen aortic root parameters were assessed in the 20% phase of the R-R interval. Reading time was compared using paired samples t-test. Inter-software agreement was calculated using the Intraclass correlation coefficient (ICC) in a 2-way mixed effects model. Differences between manual and semi-automatic measurements were evaluated using Bland-Altman analysis.ResultsThe time needed for evaluation using semi-automatic assessment (3 min 24 s ± 1 min 7 s) was significantly lower (p<0.001) compared to a fully manual approach (6 min 31 sec ± 1 min 1 sec). Excellent inter-software agreement was found (ICC = 0.93 ± 0.0; range:0.90–0.95).The same prosthesis size from manual and semi-automatic measurements was selected in 92% of cases, when sizing was based on annular area. Prosthesis sizing based on annular short diameter and perimeter agreed in 99% and 96% cases, respectively.ConclusionUse of semi-automatic software in pre-TAVI evaluation results in comparable results in respect of measurements and selected valve prosthesis size, while necessary reading time is significantly lower.

Highlights

Transcatheter aortic valve implantation (TAVI) provides a minimally invasive therapeutical option to patients with severe aortic valve stenosis who are not eligible for conventional valve replacement [1,2,3,4,5,6,7,8]
The time needed for evaluation using semi-automatic assessment (3 min 24 s ± 1 min 7 s) was significantly lower (p
multidetector row CT (MDCT) assessment of aortic root was recently considered a predictive factor for severity of paravalvular leakage, which further supports the role of MDCT in TAVI planning [11, 14]

Summary

Introduction

Transcatheter aortic valve implantation (TAVI) provides a minimally invasive therapeutical option to patients with severe aortic valve stenosis who are not eligible for conventional valve replacement [1,2,3,4,5,6,7,8]. Precise assessment of aortic root prior to the intervention is fundamental for patient’s outcome. It allows for recognition of suitable patients, selection of the correct valve for replacement, and minimizes the risk of peri-procedural complications [9]. Tedious manual assessment of aortic root dimensions is highly sophisticated and requires an experienced reader who is able to reliably extract necessary data from the scan. Semi-automatic software is designed to determine anatomical structures of aortic annulus on MDCT scan, allowing partial automation of measurements and in this respect simplifying the assessment, hereby making TAVI planning faster. Pre-procedural TAVI planning requires highly sophisticated and time-consuming manual measurements performed by experienced readers. The aim of this study was to evaluate differences between manual and semi-automatic measurements in terms of agreement and time.

Methods

Results

Conclusion