Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada; University of Cambridge School of Clinical Medicine, Cambridge, UK.
Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Cardiology, Fribourg University and Hospital, Fribourg, Switzerland.
J Cardiovasc Comput Tomogr. 2020 Sep-Oct;14(5):407-413. doi: 10.1016/j.jcct.2020.01.008. Epub 2020 Jan 31.
CT measurement of supra-annular area (SA) has been proposed as an alternative to annular area (AA) for sizing of trancatheter valves in biscuspid aortic valves (BAV). This study examines the reproducibility of SA and AA measurements and their potential impact on downstream transcatheter heart valve sizing and clinical outcomes.
44 consecutive patients (mean age: 73 ± 15 years, 57% male) undergoing CTA with subsequent SAPIEN 3 valve insertion for severe bicuspid aortic stenosis (AS) were included. AA was measured at the basal ring. SA was measured by generating a circle defined by the intercommisural distance. AA and SA were measured by 2 independent observers. Baseline characteristics, TAVR procedural data, and discharge echocardiography data were collected.
The SA was significantly larger than the AA (562 ± 146mm2 vs. 518 ± 112mm2,p = 0.013). Interobserver agreement was high using both techniques (ICC AA = 0.98,p < 0.001; SA = 0.80,p < 0.001), but with narrower limits of agreement with AA measurements (mean difference (limits of agreement): AA = -3mm2 (22; 19), SA = -16mm2 (-92; 76)). AA-based device sizing demonstrated substantial agreement with final valve inserted (κ = 0.72,p < 0.001), while SA demonstrated fair agreement (κ = 0.40,p < 0.001). There was no difference in post TAVR gradients, paravalvular leakage or valve success between patients with concordant sizing between AA and SA, and those in whom SA would have suggested an alternate valve size.
Supra-annular sizing is less reproducible than annular sizing, with no difference in procedural complication rates in patients in whom supra-annular sizing would have altered the device size used. These results suggest no role for supra-annular sizing in current clinical practice.
在二叶式主动脉瓣（BAV）中，经导管主动脉瓣置换术（TAVR）时，人们提出用瓣上区域（SA）取代瓣环区域（AA）来测量瓣环大小。本研究旨在检验 SA 和 AA 测量的可重复性，及其对后续 TAVR 瓣膜尺寸选择和临床结果的潜在影响。
本研究共纳入 44 例连续患者（平均年龄 73±15 岁，57%为男性），因严重二叶式主动脉瓣狭窄（AS）行 CT 血管造影（CTA）检查，随后行 SAPIEN 3 瓣膜植入术。AA 在瓣环基底测量，SA 则通过生成由房室结距离定义的圆来测量。由 2 位独立观察者测量 AA 和 SA。收集基线特征、TAVR 手术数据和出院时超声心动图数据。
SA 明显大于 AA（562±146mm2 比 518±112mm2，p=0.013）。两种技术的观察者间一致性均较高（AA 的 ICC 为 0.98，p<0.001；SA 的 ICC 为 0.80，p<0.001），但与 AA 测量相比，一致性的限制范围更窄（平均差值（一致性限制范围）：AA=-3mm2（22；19），SA=-16mm2（-92；76））。AA 指导的器械尺寸选择与最终植入瓣膜具有高度一致性（κ=0.72，p<0.001），而 SA 则显示出适度一致性（κ=0.40，p<0.001）。在 AA 和 SA 尺寸一致的患者和 SA 建议更换瓣膜尺寸的患者中，TAVR 后梯度、瓣周漏或瓣膜成功之间无差异。
SA 比 AA 更难重复测量，而在 SA 会改变所用器械尺寸的患者中，手术并发症发生率无差异。这些结果表明，在当前的临床实践中，SA 测量没有作用。
