Document Detail

Objective quantification of aortic valvular structures by cardiac computed tomography angiography in patients considered for transcatheter aortic valve implantation.
MedLine Citation:
PMID:  23281089     Owner:  NLM     Status:  In-Data-Review    
PURPOSE: To test the ability of a model-based segmentation of the aortic root for consistent assessment of aortic valve structures in patients considered for transcatheter aortic valve implantation (TAVI) who underwent 256-slice cardiac computed tomography (CT).
METHODS: Consecutive patients (n = 49) with symptomatic severe aortic stenosis considered for TAVI and patients without aortic stenosis (n = 17) underwent cardiac CT. Images were evaluated by two independent observers who measured the diameter of the aortic annulus and its distance to both coronary ostia (1) manually and (2) software-assisted. All acquired measures were compared with each other and to (3) fully automatic quantification.
RESULTS: High correlations were observed for 3D measures of the aortic annulus conducted on multiple oblique planes (r = 0.87 and 0.84 between observers and model-based measures, and r = 0.81 between observers). Reproducibility was further improved by software-assisted versus manual assessment for all the acquired variables (r = 0.98 versus 0.81 for annulus diameter, r = 0.94 versus 0.85 for distance to the left coronary ostium, P < 0.01 for both). Thus, using software-assisted measurements very low limits of agreement were observed for the annulus diameter (95%CI of -1.2 to 0.6 mm) and within very low time-spent (0.6 ± 0.1 min for software-assisted versus 1.6 ± 0.3 min per patient for manual assessment, P < 0.001). Assessment of the aortic annulus using the 3D model-based instead of manual 2D-coronal measurements would have modified the implantation strategy in 12 of 49 patients (25%) with aortic stenosis. Four of 12 patients with potentially modified implantation strategy yielded postprocedural moderate paravalvular regurgitation, which may have been avoided by implantation of a larger prosthesis, as suggested by automatic 3D measures.
CONCLUSION: Our study highlights the usefulness of software-assisted preprocedural assessment of the aortic annulus in patients considered for TAVI. © 2012 Wiley Periodicals, Inc.
Grigorios Korosoglou; Gitsios Gitsioudis; Irina Waechter-Stehle; Juergen Weese; Ulrike Krumsdorf; Emmanuel Chorianopoulos; Waldemar Hosch; Hans-Ulrich Kauczor; Hugo A Katus; Raffi Bekeredjian
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  81     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  148-59     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
University of Heidelberg, Department of Cardiology, Heidelberg, Germany.
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