Aortic annulus diameter determination by multidetector computed tomography: reproducibility, applicability, and implications for transcatheter aortic valve implantation.

OBJECTIVES This study sought to determine the most reproducible multidetector computed tomography (MDCT) measurements of the aortic annulus and to determine methods to improve the applicability of these measurements for transcatheter aortic valve implantation. BACKGROUND The reproducibility and applicability of MDCT annular measurements to guide transcatheter aortic valve implantation remain unclear. METHODS Annular measurements were performed in 50 patients planed for transcatheter aortic valve implantation in multiple planes: basal ring (short- and long-axis, mean diameter, area-derived diameter), coronal, sagittal, and 3-chamber projections. A theoretical model was developed taking into account the differences between the most reproducible MDCT measurements and transesophageal echocardiography to guide valve size choice. RESULTS The most reproducible measurements were the area-derived diameter and basal ring average diameter (inter-reader intraclass correlation coefficient: 0.87 [95% confidence interval: 0.81 to 0.92] and 0.80 [95% confidence interval: 0.70 to 0.87]; respectively; intrareader >0.90 for all readers). These were generally larger than transesophageal echocardiography diameters (mean difference of 1.5 ± 1.6 mm and 1.1 ± 1.7 mm, respectively). When a strategy of valve-sizing is undertaken using these CT measurements using an echocardiographic sizing scale, a different THV size would be selected in 44% and 40% of cases, respectively. When adjusting the sizing cutoffs to account for the differences in observed diameters, this was reduced to 10% to 12% (p < 0.01 for both, respectively). CONCLUSIONS The most reproducible MDCT measurements of the annulus are the area-derived diameter and basal ring average diameter, with derived values generally larger than those obtained with echocardiography. If MDCT is used for valve sizing, a strategy incorporating these differences may be important. MDCT using these easily derived measurements may be ideally suited to sizing transcatheter aortic valves as they account for the eccentricity of the aortic annulus, are reproducible, and are noninvasive.

[1]  Katja Zeppenfeld,et al.  Head-to-head comparison of contrast-enhanced magnetic resonance imaging and electroanatomical voltage mapping to assess post-infarct scar characteristics in patients with ventricular tachycardias: real-time image integration and reversed registration. , 2011, European heart journal.

[2]  Alain Cribier,et al.  Percutaneous transarterial aortic valve implantation: what do we know? , 2011, European heart journal.

[3]  Lukas Altwegg,et al.  Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis , 2007, Circulation.

[4]  A. Shiran,et al.  Accuracy and reproducibility of left ventricular outflow tract diameter measurement using transthoracic when compared with transesophageal echocardiography in systole and diastole. , 2009, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[5]  P. Serruys,et al.  Assessment of the aortic annulus by multislice computed tomography, contrast aortography, and trans‐thoracic echocardiography in patients referred for transcatheter aortic valve implantation , 2011, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[6]  J. Webb,et al.  A new transcatheter aortic valve and percutaneous valve delivery system. , 2009, Journal of the American College of Cardiology.

[7]  Robert H. Anderson,et al.  Anatomy of the Aortic Valvar Complex and Its Implications for Transcatheter Implantation of the Aortic Valve , 2008, Circulation. Cardiovascular interventions.

[8]  A. Stillman,et al.  Can balloon aortic valvuloplasty help determine appropriate transcatheter aortic valve size? , 2008, JACC. Cardiovascular interventions.

[9]  R. Moss,et al.  Transcatheter aortic valve implantation in aortic stenosis: the role of echocardiography. , 2011, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[10]  Adriaan Moelker,et al.  Three dimensional evaluation of the aortic annulus using multislice computer tomography: are manufacturer's guidelines for sizing for percutaneous aortic valve replacement helpful? , 2010, European heart journal.

[11]  J. Manson,et al.  Reproducibility of plasma hormone levels in postmenopausal women over a 2-3-year period. , 1995, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[12]  T. Felderhoff,et al.  Progress and Current Status of Percutaneous Aortic Valve Replacement: Results of Three Device Generations of the CoreValve Revalving System , 2008, Circulation. Cardiovascular interventions.

[13]  F. Maisano,et al.  Incidence and Predictors of Early and Late Mortality After Transcatheter Aortic Valve Implantation in 663 Patients With Severe Aortic Stenosis , 2011, Circulation.

[14]  Patrick W Serruys,et al.  Cardiac CT: necessary for precise sizing for transcatheter aortic implantation. , 2010, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[15]  P. Serruys,et al.  The use of MSCT for the evaluation of the aortic root before transcutaneous aortic valve implantation: the Rotterdam approach. , 2010, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[16]  Christopher E. Buller,et al.  Percutaneous Aortic Valve Implantation Retrograde From the Femoral Artery , 2006, Circulation.

[17]  J. Leipsic,et al.  Multislice computed tomography for prediction of optimal angiographic deployment projections during transcatheter aortic valve implantation. , 2010, JACC. Cardiovascular interventions.

[18]  J. Chambers,et al.  Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[19]  Jeroen J. Bax,et al.  Role of multislice computed tomography in transcatheter aortic valve replacement. , 2009, The American journal of cardiology.

[20]  Jeroen J. Bax,et al.  Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. , 2008, JACC. Cardiovascular imaging.

[21]  R. Moss,et al.  Role of echocardiography in percutaneous aortic valve implantation. , 2008, JACC. Cardiovascular imaging.

[22]  Fabien Hyafil,et al.  Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. , 2010, Journal of the American College of Cardiology.

[23]  Volkmar Falk,et al.  Transapical aortic valve implantation: step by step. , 2009, The Annals of thoracic surgery.