Document Detail


Aortic annulus diameter determination by multidetector computed tomography: reproducibility, applicability, and implications for transcatheter aortic valve implantation.
MedLine Citation:
PMID:  22115665     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to determine the most reproducible multidetector computed tomography (MDCT) measurements of the aortic annulus and to determine methods to improve the applicability of these measurements for transcatheter aortic valve implantation.
BACKGROUND: The reproducibility and applicability of MDCT annular measurements to guide transcatheter aortic valve implantation remain unclear.
METHODS: Annular measurements were performed in 50 patients planed for transcatheter aortic valve implantation in multiple planes: basal ring (short- and long-axis, mean diameter, area-derived diameter), coronal, sagittal, and 3-chamber projections. A theoretical model was developed taking into account the differences between the most reproducible MDCT measurements and transesophageal echocardiography to guide valve size choice.
RESULTS: The most reproducible measurements were the area-derived diameter and basal ring average diameter (inter-reader intraclass correlation coefficient: 0.87 [95% confidence interval: 0.81 to 0.92] and 0.80 [95% confidence interval: 0.70 to 0.87]; respectively; intrareader >0.90 for all readers). These were generally larger than transesophageal echocardiography diameters (mean difference of 1.5 ± 1.6 mm and 1.1 ± 1.7 mm, respectively). When a strategy of valve-sizing is undertaken using these CT measurements using an echocardiographic sizing scale, a different THV size would be selected in 44% and 40% of cases, respectively. When adjusting the sizing cutoffs to account for the differences in observed diameters, this was reduced to 10% to 12% (p < 0.01 for both, respectively).
CONCLUSIONS: The most reproducible MDCT measurements of the annulus are the area-derived diameter and basal ring average diameter, with derived values generally larger than those obtained with echocardiography. If MDCT is used for valve sizing, a strategy incorporating these differences may be important. MDCT using these easily derived measurements may be ideally suited to sizing transcatheter aortic valves as they account for the eccentricity of the aortic annulus, are reproducible, and are noninvasive.
Authors:
Ronen Gurvitch; John G Webb; Ren Yuan; Mark Johnson; Cameron Hague; Alexander B Willson; Stefan Toggweiler; David A Wood; Jian Ye; Robert Moss; Christopher R Thompson; Stephan Achenbach; James K Min; Troy M Labounty; Ricardo Cury; Jonathon Leipsic
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  4     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-25     Completed Date:  2012-03-25     Revised Date:  2012-08-29    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1235-45     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve / radiography*,  ultrasonography
Chi-Square Distribution
Echocardiography, Transesophageal
Female
Heart Catheterization* / instrumentation
Heart Valve Diseases / radiography*,  therapy*,  ultrasonography
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / instrumentation,  methods*
Humans
Male
Models, Cardiovascular
Patient Selection
Predictive Value of Tests
Prosthesis Design
Reproducibility of Results
Tomography, X-Ray Computed*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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