Abstract
Background and PurposeAccurate measurement of aortic annulus diameter is crucial for choosing suitable prosthetic size for transcatheter aortic valve implantation (TAVI). Several imaging methods are available for the measurement, but significant variability between different modalities has been observed. The purpose of this study was to systematically compare the measurements of aortic annulus diameter between multi-detector computed tomography (MDCT), transthoracic echocardiography (TTE), and transesophegeal echocardiography (TEE).MethodsPubMed and EMBASE databases between January 2000 and January 2012 were searched. We extracted data from eligible studies evaluating the aortic annulus diameter by MDCT and echocardiography (TTE, TEE, or both). We performed a random-effects meta-analysis to calculate the weighted mean differences of aortic annulus diameter measurement between MDCT, TTE, and TEE.ResultsA total of 10 eligible studies involving 581 subjects with aortic valve stenosis were included. Aortic annulus diameter measured on coronal view by MDCT (25.3±0.52 mm) was respectively larger than that measured on sagittal view by MDCT (22.7±0.37 mm), TTE (22.6±0.28 mm), and TEE (23.1±0.32 mm). The weighted mean difference of aortic annulus diameter between coronal view by MDCT and TTE these two methods was 2.97 mm, followed by the weighted mean difference of 2.53 mm between coronal view and sagittal view by MDCT, and the mean difference of 1.74 mm between coronal view on MDCT and TEE (P<0.0001 for all). The weighted mean difference of aortic annulus diameter measurement between TEE and TTE was significant but somewhat small (0.45 mm, P = 0.007).ConclusionAortic annulus diameter measured on coronal view by MDCT was robustly and significantly larger than that obtained on sagittal view by MDCT, TTE, or TEE. Such variability of aortic annulus diameter measurement by different imaging modalities cannot be ignored when developing optimal strategies for selection of prosthetic valve size in TAVI.
Highlights
Transcatheter aortic valve implantation (TAVI) has recently become an alternative to surgical aortic replacement in patients with severe aortic valve stenosis (AS), who are at a high surgical risk or contraindication to conventional aortic valve replacement surgery [1,2,3]
Some studies showed that aortic annulus diameter measured by multi-detector computed tomography (MDCT) was significantly larger than that measured by transthoracic echocardiography (TTE) or transesophegeal echocardiography (TEE) [7,8] whereas some reported the largest aortic annulus detected by TEE [6]
The weighted mean difference of aortic annulus diameter between these two methods was 2.97 mm (Figure 2), followed by that between coronal view and sagittal view by MDCT (2.53 mm; 95% CI, 1.38 to 3.68 mm) (Figure 3), and that between coronal view by MDCT and TEE (1.74 mm; 95% CI, 1.30 to 2.19 mm) (Figure 4) (P,0.0001 for all)
Summary
Transcatheter aortic valve implantation (TAVI) has recently become an alternative to surgical aortic replacement in patients with severe aortic valve stenosis (AS), who are at a high surgical risk or contraindication to conventional aortic valve replacement surgery [1,2,3]. For TAVI, accurate measurement of aortic annulus diameter is crucial for choosing suitable prosthetic size. In the absence of gold standard for aortic valve sizing, it is important to learn the sources of variability in the measurement of aortic annulus diameter between different imaging modalities. To provide useful information to help therapeutic decision making, we conducted a systematic review and meta-analysis to compare the overall mean differences in aortic annulus diameter measurement between TTE, TEE and MDCT in AS patients. Accurate measurement of aortic annulus diameter is crucial for choosing suitable prosthetic size for transcatheter aortic valve implantation (TAVI). The purpose of this study was to systematically compare the measurements of aortic annulus diameter between multi-detector computed tomography (MDCT), transthoracic echocardiography (TTE), and transesophegeal echocardiography (TEE)
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