Head-to-Head Comparison of Different Software Solutions for AVC Quantification Using Contrast-Enhanced MDCT.

Ruben Evertz,Karl Toischer,Gerd Hasenfuß,Torben Lange,Johannes T Kowallick,Sebastian Hub,Sören J Backhaus,Andreas Schuster

doi:10.3390/jcm10173970

Ruben Evertz, Karl Toischer + Show 6 more

Open Access

https://doi.org/10.3390/jcm10173970

Copy DOI

Abstract

Aortic valve calcification (AVC) in aortic stenosis patients has diagnostic and prognostic implications. Little is known about the interchangeability of AVC obtained from different multidetector computed tomography (MDCT) software solutions. Contrast-enhanced MDCT data sets of 50 randomly selected aortic stenosis patients were analysed using three different software vendors (3Mensio, CVI42, Syngo.Via). A subset of 10 patients were analysed twice for the estimation of intra-observer variability. Intra- and inter-observer variability were determined using the ICC reliability method, Bland-Altman analysis and coefficients of variation. No differences were revealed between the software solutions in the AVC calculations (3Mensio 941 ± 623, Syngo.Via 948 mm3 ± 655, CVI42 941 ± 637; p = 0.455). The best inter-vendor agreement was found between the CVI42 and the Syngo.Via (ICC 0.997 (CI 0.995–0.998)), followed by the 3Mensio and the CVI42 (ICC 0.996 (CI 0.922–0.998)), and the 3Mensio and the Syngo.Via (ICC 0.992 (CI 0.986–0.995)). There was excellent intra- (3Mensio: ICC 0.999 (0.995–1.000); CVI42: ICC 1.000 (0.999–1.000); Syngo.Via: ICC 0.998 (0.993–1.000)) and inter-observer variability (3Mensio: ICC 1.000 (0.999–1.000); CVI42: ICC 1.000 (1.000–1.000); Syngo.Via: ICC 0.996 (0.985–0.999)) for all software types. Contrast-enhanced MDCT-derived AVC scores are interchangeable between and reproducible within different commercially available software solutions. This is important since sufficient reproducibility, interchangeability and valid results represent prerequisites for accurate TAVR planning and its widespread clinical use.

Highlights

Aortic stenosis (AS) is the most common valvular heart disease in the elderly population in Europe and North America [1,2]
In all patients the presence of severe AS was confirmed by transthoracic echocardiography (TTE) and the AS was classified according to current guidelines [1]
All patients were suffering from severe AS, which was diagnosed according to current guideline recommendations [1]

Summary

Introduction

Aortic stenosis (AS) is the most common valvular heart disease in the elderly population in Europe and North America [1,2]. Whilst historically surgery was the only therapeutic approach, treatment options have changed in the last 19 years. 2002, the first transcatheter aortic valve replacement (TAVR) was performed [3]. TAVR was initially only performed in patients with very high risk, TAVR has since become the standard treatment for the elderly population and can be safely recommended to lowrisk patient populations [4,5]. In 2018, almost 21,000 TAVR procedures were performed in Germany and there has been a steady increase in the number of interventions over the last 10 years [6]. Depending on the transvalvular flow and the transvalvular pressure gradient, different AS subtypes can be distinguished on the basis of echocardiography. Data from several studies suggest a prevalence of (paradoxical) low-flow low-gradient AS in up to

Objectives

Methods

Results

Discussion

Conclusion