Department of Interventional Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiology, University Hospital Galway, Galway, Ireland.
Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
JACC Cardiovasc Interv. 2014 Jun;7(6):652-61. doi: 10.1016/j.jcin.2014.02.010.
This study sought to assess the differential adherence to transcatheter heart valve (THV)-oversizing principles between transesophageal echocardiography (TEE) and multislice computed tomography (CT) and its impact on the incidence of paravalvular leak (PVL).
CT has emerged as an alternative to 2-dimensional TEE for THV sizing.
In our early experience, TEE-derived aortic annular diameters determined THV size selection. CT datasets originally obtained for vascular screening were retrospectively interrogated to determine CT-derived annular diameters. Annular dimensions and expected THV oversizing were compared between TEE and CT. The incidence of PVL was correlated to TEE- and CT-based oversizing calculations.
Using TEE-derived annulus measurements, 157 patients underwent CoreValve implantation (23 mm: n = 66; 29 mm: n = 91). The estimated THV oversizing on the basis of TEE was 20.1 ± 8.2%. Retrospective CT analysis yielded larger annular diameters than TEE (p < 0.0001). When these CT diameters were used to recalculate the percentage of oversizing achieved with the TEE-selected CoreValve, the actual THV oversizing was only 10.4 ± 7.8%. Consequently, CT analysis suggested that up to 50% of patients received an inappropriate CoreValve size. When CT-based sizing criteria were satisfied, the incidence of PVL was 21% lower than that with echocardiography (14% vs. 35%; p = 0.003). Adherence to CT-based oversizing was independently associated with a reduced incidence of PVL (odds ratio 0.36; 95% confidence interval: 0.14 to 0.90; p = 0.029); adherence to TEE-based sizing was not.
Retrospective CT-based annular analysis revealed that CoreValve size selection by TEE was incorrect in 50% of patients. The percentage of oversizing with CT was one-half of that calculated with TEE resulting in the majority of patients receiving a THV that was too small.
本研究旨在评估经胸超声心动图（TEE）与多层螺旋 CT（MSCT）在经导管心脏瓣膜（THV）过度扩张原则方面的差异，并探讨其对瓣周漏（PVL）发生率的影响。
CT 已成为 THV 大小测量的替代方法。
在我们的早期经验中，TEE 测量的主动脉瓣环直径决定了 THV 的大小选择。对最初用于血管筛查的 CT 数据集进行回顾性分析，以确定 CT 测量的瓣环直径。比较 TEE 和 CT 之间瓣环尺寸和预期的 THV 过度扩张。将 PVL 的发生率与 TEE 和 CT 为基础的过度扩张计算相关联。
使用 TEE 测量的瓣环尺寸，对 157 例患者行 CoreValve 植入术（23mm：n=66；29mm：n=91）。基于 TEE 的估计 THV 过度扩张率为 20.1±8.2%。MSCT 分析得到的瓣环直径大于 TEE（p<0.0001）。当使用这些 CT 直径重新计算 TEE 选择的 CoreValve 达到的过度扩张百分比时，实际 THV 过度扩张仅为 10.4±7.8%。因此，CT 分析表明，多达 50%的患者接受了不合适的 CoreValve 尺寸。当符合 CT 为基础的尺寸标准时，PVL 的发生率比超声心动图低 21%（14%vs.35%；p=0.003）。遵循 CT 为基础的过度扩张标准与降低 PVL 发生率独立相关（比值比 0.36；95%置信区间：0.14 至 0.90；p=0.029）；而遵循 TEE 为基础的尺寸标准则不然。
回顾性 CT 为基础的瓣环分析显示，TEE 选择的 CoreValve 尺寸在 50%的患者中是错误的。CT 计算的过度扩张百分比是 TEE 的一半，导致大多数患者接受了尺寸过小的 THV。
