Podlesnikar Tomaz, Prihadi Edgard A, van Rosendael Philippe J, Vollema E Mara, van der Kley Frank, de Weger Arend, Ajmone Marsan Nina, Naji Franjo, Fras Zlatko, Bax Jeroen J, Delgado Victoria
Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardio-Thoracic Surgery, Heart and Lung Center, Leiden University Medical Center, Leiden, The Netherlands.
Am J Cardiol. 2018 Jan 1;121(1):86-93. doi: 10.1016/j.amjcard.2017.09.016. Epub 2017 Oct 10.
Accurate aortic annulus sizing is key for selection of appropriate transcatheter aortic valve implantation (TAVI) prosthesis size. The present study compared novel automated 3-dimensional (3D) transesophageal echocardiography (TEE) software and multidetector row computed tomography (MDCT) for aortic annulus sizing and investigated the influence of the quantity of aortic valve calcium (AVC) on the selection of TAVI prosthesis size. A total of 83 patients with severe aortic stenosis undergoing TAVI were evaluated. Maximal and minimal aortic annulus diameter, perimeter, and area were measured. AVC was assessed with computed tomography. The low and high AVC burden groups were defined according to the median AVC score. Overall, 3D TEE measurements slightly underestimated the aortic annulus dimensions as compared with MDCT (mean differences between maximum, minimum diameter, perimeter, and area: -1.7 mm, 0.5 mm, -2.7 mm, and -13 mm, respectively). The agreement between 3D TEE and MDCT on aortic annulus dimensions was superior among patients with low AVC burden (<3,025 arbitrary units) compared with patients with high AVC burden (≥3,025 arbitrary units). The interobserver variability was excellent for both methods. 3D TEE and MDCT led to the same prosthesis size selection in 88%, 95%, and 81% of patients in the total population, the low, and the high AVC burden group, respectively. In conclusion, the novel automated 3D TEE imaging software allows accurate and highly reproducible measurements of the aortic annulus dimensions and shows excellent agreement with MDCT to determine the TAVI prosthesis size, particularly in patients with low AVC burden.
准确测量主动脉瓣环大小是选择合适的经导管主动脉瓣植入术（TAVI）假体尺寸的关键。本研究比较了新型自动化三维（3D）经食管超声心动图（TEE）软件和多排螺旋计算机断层扫描（MDCT）测量主动脉瓣环大小的情况，并研究了主动脉瓣钙化（AVC）量对TAVI假体尺寸选择的影响。共评估了83例接受TAVI的重度主动脉瓣狭窄患者。测量了主动脉瓣环的最大和最小直径、周长和面积。通过计算机断层扫描评估AVC。根据AVC评分中位数定义低AVC负荷组和高AVC负荷组。总体而言，与MDCT相比，3D TEE测量结果略微低估了主动脉瓣环尺寸（最大、最小直径、周长和面积的平均差异分别为-1.7毫米、0.5毫米、-2.7毫米和-13毫米）。与高AVC负荷（≥3025任意单位）的患者相比，低AVC负荷（<3025任意单位）的患者中，3D TEE和MDCT在主动脉瓣环尺寸上的一致性更好。两种方法的观察者间变异性都很好。在总人群、低AVC负荷组和高AVC负荷组中，3D TEE和MDCT分别在88%、95%和81%的患者中导致相同的假体尺寸选择。总之，新型自动化3D TEE成像软件能够准确且高度可重复地测量主动脉瓣环尺寸，并且在确定TAVI假体尺寸方面与MDCT显示出极好的一致性，尤其是在低AVC负荷的患者中。
