Abstract 20090: Three Dimensional Measurement of Aortic Annulus Using En-Face View and Multiplanar Reconstruction
Background: Accurate measurements of the aortic annulus are critical for valve sizing in transcatheter aortic valve replacement (TAVR). Contrast enhanced multiple detector computed tomography (MDCT) is the current standard, but patients with renal dysfunction may be at risk for contrast nephropathy, and the image quality may be degraded in patients with atrial fibrillation. Multiplanar reconstruction (MPR) of 3D echocardiographic images has been shown to be equally accurate, but the simplified direct en-face measurement performed on the 3D rendered image has not been evaluated. The aim of our study was to compare the accuracy of MPR and en-face methods of 3D echocardiography versus the MDCT assessment of the aortic valve annulus in patients referred for TAVR.
Methods: MPR and en-face measurements of 3D echocardiography of the aortic annulus were performed blinded to MDCT results in 56 patients with severe, symptomatic aortic stenosis who had both contrast MDCT and 3D-TEE before TAVR. Annulus area, orthogonal maximum and minimum diameters were measured using commercially available software, and were compared with corresponding MDCT measurements.
Results: The correlation between MPR and MDCT LVOT area measurements was excellent (mean difference 0.04±0.08 cm, r=0.84, p<0.001; see figure). En-face measurements significantly underestimated LVOT area (mean difference 0.30±0.09 cm; r=0.74, p<0.01). There was also a good correlation between MPR and MDCT in minimum diameter measurement (r=0.80, p<0.05; mean difference 0.04±0.02cm). The correlation with MDCT was weaker for the maximum diameter measured by either MPR (r=0.68) or en-face measurements (r=0.65).
Conclusions: In patients referred for TAVR, MPR measurements of LVOT area may be used as an alternative to MDCT for TAVR planning. The rapid en-face method is associated with systematic underestimation when compared to CT, and cannot be recommended at this time.
Author Disclosures: Y. Zhu: None. J.J. Thaden: None. C. Pislaru: None. V.T. Nkomo: None. P.A. Pellikka: None. J.F. Maalouf: None. T.A. Foley: None. K.L. Greason: None. S.V. Pislaru: None. S.A. Luis: None.
- © 2016 by American Heart Association, Inc.