Feasibility and accuracy of three-dimensional transthoracic echocardiography vs. multidetector computed tomography in the evaluation of aortic valve annulus in patient candidates to transcatheter aortic valve implantation

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Abstract

AIMS: Proper measurement of the aortic annulus (AoA) is crucial for the success of transcatheter aortic valve implantation (TAVI). Transthoracic echocardiography (TTE) is the first step to assess AoA diameter, but a two-dimensional TTE (2DTTE) measurement is no longer accepted as the sole determinant of prosthetic size. The aims of the study were to evaluate feasibility and accuracy of three-dimensional TTE (3DTTE) estimation of AoA dimensions in comparison with multidetector computer tomography (MDCT).

METHODS AND RESULTS: We enrolled 100 consecutive patients referred for TAVI. Feasibility of AoA evaluation was 91% for 3DTTE and in 90% for MDCT. In 81 of 100 patients, AoA maximum diameter (max-D), minimum diameter (min-D), and area were measured and compared using 2DTTE, 3DTTE, and MDCT. Image quality of 3DTTE was sufficient in 47, good in 46 and optimal in 7%. High correlations (P <0.001) were found between MDCT and 3DTTE (max-D: r = 0.89; min-D r = 0.86; area: r = 0.93), and between MDCT and 2DTTE (min-D: r = 0.81; area 0.78). The 3DTTE measurements were found to be highly reproducible on intra- and interobserver variability analyses. Regarding the choice of prosthesis size, agreement between 3DTTE and MDCT was very good (k = 0.84, P <0.001) while it was poor between 2DTTE and MDCT (k = 0.36, P <0.001).

CONCLUSIONS: 3DTTE may be a valid imaging alternative in patients unsuitable for MDCT during the preoperative evaluation for TAVI. Evaluation of AoA through 3DTTE is feasible, and measurements closely approximate those of MDCT thus improving TTE accuracy in identifying the correct prosthesis size.

Original languageEnglish
Pages (from-to)1316-1323
Number of pages8
JournalEuropean Heart Journal Cardiovascular Imaging
Volume15
Issue number12
DOIs
Publication statusPublished - Dec 1 2014

Fingerprint

Three-Dimensional Echocardiography
Multidetector Computed Tomography
Aortic Valve
Echocardiography
Tomography
Prostheses and Implants
Transcatheter Aortic Valve Replacement
Observer Variation

Keywords

  • Aortic valve stenosis
  • Multidetector computer tomography
  • Three-dimensional transthoracic echocardiography
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{542fd473c2e64b6dae8f8b862884d2b8,
title = "Feasibility and accuracy of three-dimensional transthoracic echocardiography vs. multidetector computed tomography in the evaluation of aortic valve annulus in patient candidates to transcatheter aortic valve implantation",
abstract = "AIMS: Proper measurement of the aortic annulus (AoA) is crucial for the success of transcatheter aortic valve implantation (TAVI). Transthoracic echocardiography (TTE) is the first step to assess AoA diameter, but a two-dimensional TTE (2DTTE) measurement is no longer accepted as the sole determinant of prosthetic size. The aims of the study were to evaluate feasibility and accuracy of three-dimensional TTE (3DTTE) estimation of AoA dimensions in comparison with multidetector computer tomography (MDCT).METHODS AND RESULTS: We enrolled 100 consecutive patients referred for TAVI. Feasibility of AoA evaluation was 91{\%} for 3DTTE and in 90{\%} for MDCT. In 81 of 100 patients, AoA maximum diameter (max-D), minimum diameter (min-D), and area were measured and compared using 2DTTE, 3DTTE, and MDCT. Image quality of 3DTTE was sufficient in 47, good in 46 and optimal in 7{\%}. High correlations (P <0.001) were found between MDCT and 3DTTE (max-D: r = 0.89; min-D r = 0.86; area: r = 0.93), and between MDCT and 2DTTE (min-D: r = 0.81; area 0.78). The 3DTTE measurements were found to be highly reproducible on intra- and interobserver variability analyses. Regarding the choice of prosthesis size, agreement between 3DTTE and MDCT was very good (k = 0.84, P <0.001) while it was poor between 2DTTE and MDCT (k = 0.36, P <0.001).CONCLUSIONS: 3DTTE may be a valid imaging alternative in patients unsuitable for MDCT during the preoperative evaluation for TAVI. Evaluation of AoA through 3DTTE is feasible, and measurements closely approximate those of MDCT thus improving TTE accuracy in identifying the correct prosthesis size.",
keywords = "Aortic valve stenosis, Multidetector computer tomography, Three-dimensional transthoracic echocardiography, Transcatheter aortic valve implantation",
author = "Gloria Tamborini and Laura Fusini and Manuela Muratori and Claudia Cefal{\`u} and Paola Gripari and Ali, {Sarah G hulam} and Gianluca Pontone and Daniele Andreini and Bartorelli, {Antonio L.} and Francesco Alamanni and Cesare Fiorentini and Mauro Pepi",
year = "2014",
month = "12",
day = "1",
doi = "10.1093/ehjci/jeu157",
language = "English",
volume = "15",
pages = "1316--1323",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "2047-2404",
publisher = "Oxford University Press",
number = "12",

}

TY - JOUR

T1 - Feasibility and accuracy of three-dimensional transthoracic echocardiography vs. multidetector computed tomography in the evaluation of aortic valve annulus in patient candidates to transcatheter aortic valve implantation

AU - Tamborini, Gloria

AU - Fusini, Laura

AU - Muratori, Manuela

AU - Cefalù, Claudia

AU - Gripari, Paola

AU - Ali, Sarah G hulam

AU - Pontone, Gianluca

AU - Andreini, Daniele

AU - Bartorelli, Antonio L.

AU - Alamanni, Francesco

AU - Fiorentini, Cesare

AU - Pepi, Mauro

PY - 2014/12/1

Y1 - 2014/12/1

N2 - AIMS: Proper measurement of the aortic annulus (AoA) is crucial for the success of transcatheter aortic valve implantation (TAVI). Transthoracic echocardiography (TTE) is the first step to assess AoA diameter, but a two-dimensional TTE (2DTTE) measurement is no longer accepted as the sole determinant of prosthetic size. The aims of the study were to evaluate feasibility and accuracy of three-dimensional TTE (3DTTE) estimation of AoA dimensions in comparison with multidetector computer tomography (MDCT).METHODS AND RESULTS: We enrolled 100 consecutive patients referred for TAVI. Feasibility of AoA evaluation was 91% for 3DTTE and in 90% for MDCT. In 81 of 100 patients, AoA maximum diameter (max-D), minimum diameter (min-D), and area were measured and compared using 2DTTE, 3DTTE, and MDCT. Image quality of 3DTTE was sufficient in 47, good in 46 and optimal in 7%. High correlations (P <0.001) were found between MDCT and 3DTTE (max-D: r = 0.89; min-D r = 0.86; area: r = 0.93), and between MDCT and 2DTTE (min-D: r = 0.81; area 0.78). The 3DTTE measurements were found to be highly reproducible on intra- and interobserver variability analyses. Regarding the choice of prosthesis size, agreement between 3DTTE and MDCT was very good (k = 0.84, P <0.001) while it was poor between 2DTTE and MDCT (k = 0.36, P <0.001).CONCLUSIONS: 3DTTE may be a valid imaging alternative in patients unsuitable for MDCT during the preoperative evaluation for TAVI. Evaluation of AoA through 3DTTE is feasible, and measurements closely approximate those of MDCT thus improving TTE accuracy in identifying the correct prosthesis size.

AB - AIMS: Proper measurement of the aortic annulus (AoA) is crucial for the success of transcatheter aortic valve implantation (TAVI). Transthoracic echocardiography (TTE) is the first step to assess AoA diameter, but a two-dimensional TTE (2DTTE) measurement is no longer accepted as the sole determinant of prosthetic size. The aims of the study were to evaluate feasibility and accuracy of three-dimensional TTE (3DTTE) estimation of AoA dimensions in comparison with multidetector computer tomography (MDCT).METHODS AND RESULTS: We enrolled 100 consecutive patients referred for TAVI. Feasibility of AoA evaluation was 91% for 3DTTE and in 90% for MDCT. In 81 of 100 patients, AoA maximum diameter (max-D), minimum diameter (min-D), and area were measured and compared using 2DTTE, 3DTTE, and MDCT. Image quality of 3DTTE was sufficient in 47, good in 46 and optimal in 7%. High correlations (P <0.001) were found between MDCT and 3DTTE (max-D: r = 0.89; min-D r = 0.86; area: r = 0.93), and between MDCT and 2DTTE (min-D: r = 0.81; area 0.78). The 3DTTE measurements were found to be highly reproducible on intra- and interobserver variability analyses. Regarding the choice of prosthesis size, agreement between 3DTTE and MDCT was very good (k = 0.84, P <0.001) while it was poor between 2DTTE and MDCT (k = 0.36, P <0.001).CONCLUSIONS: 3DTTE may be a valid imaging alternative in patients unsuitable for MDCT during the preoperative evaluation for TAVI. Evaluation of AoA through 3DTTE is feasible, and measurements closely approximate those of MDCT thus improving TTE accuracy in identifying the correct prosthesis size.

KW - Aortic valve stenosis

KW - Multidetector computer tomography

KW - Three-dimensional transthoracic echocardiography

KW - Transcatheter aortic valve implantation

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U2 - 10.1093/ehjci/jeu157

DO - 10.1093/ehjci/jeu157

M3 - Article

C2 - 25187619

AN - SCOPUS:84935068595

VL - 15

SP - 1316

EP - 1323

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 2047-2404

IS - 12

ER -