Role of Echocardiography Before Transcatheter Aortic Valve Implantation (TAVI)

Badiani, Sveeta; Lloyd, Guy

doi:10.1007/s11886-016-0715-z

Cited by 11 publications

(8 citation statements)

References 83 publications

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“…Here, a distinction needs to be made between those with low flow (conventionally considered <35 mls/m 2 ) and frequently low ejection fraction, and those with normal flow, in whom measurement inaccuracy or the inherent discordance between a mean gradient of 40 mmHg and a valve area of 1.0 cm 2 , are the more likely explanations. Ensuring the correct definition of severe AS remains an important challenge both clinically and also in critical evaluation of the literature [ 43 ].…”

Section: The Role Of Advanced Imagingmentioning

confidence: 99%

Aortic Stenosis, a Left Ventricular Disease: Insights from Advanced Imaging

et al. 2016

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Aortic stenosis (AS) is the most common primary valve disorder in the elderly with an increasing prevalence. It is increasingly clear that it is also a disease of the left ventricle (LV) rather than purely the aortic valve. The transition from left ventricular hypertrophy to fibrosis results in the eventual adverse effects on systolic and diastolic function. Appropriate selection of patients for aortic valve intervention is crucial, and current guidelines recommend aortic valve replacement in severe AS with symptoms or in asymptomatic patients with left ventricular ejection fraction (LVEF) <50 %. LVEF is not a sensitive marker and there are other parameters used in multimodality imaging techniques, including longitudinal strain, exercise stress echo and cardiac MRI that may assist in detecting subclinical and subtle LV dysfunction. These findings offer potentially better ways to evaluate patients, time surgery, predict recovery and potentially offer targets for specific therapies. This article outlines the pathophysiology behind the LV response to aortic stenosis and the role of advanced multimodality imaging in describing it.

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Section: The Role Of Advanced Imagingmentioning

confidence: 99%

Aortic Stenosis, a Left Ventricular Disease: Insights from Advanced Imaging

et al. 2016

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“…Moreover TTE provides an accurate evaluation of alterations in left and right ventricular morphology and function induced by the increase in afterload and allows to structurally and functionally investigate the other cardiac valves[12]. …”

Section: Ecocardiographymentioning

confidence: 99%

Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach

Cocchia

D’Andrea

Conte

et al. 2017

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Transcatheter aortic valve replacement (TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities should be preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. Ultrasounds represent the first line tool in evaluation of this patients giving detailed anatomic description of aortic valve complex and allowing estimating with enough reliability the hemodynamic entity of valvular stenosis. Angiography should be used to assess coronary involvement and plan a revascularization strategy before the implant. Multislice computed tomography play a central role as it can give anatomical details in order to choice the best fitting prosthesis, evaluate the morphology of the access path and detect other relevant comorbidities. Cardiovascular magnetic resonance and positron emission tomography are emergent modality helpful in aortic stenosis evaluation. The aim of this review is to give an overview on TAVR clinical and technical aspects essential for adequate selection.

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“…Determination of the prosthesis size is the decisive point of the success of the TAVR procedure. Therefore, precise cardiac imaging modalities have become the backbone in the pre‐TAVR evaluation . Recent advances in our knowledge of aortic root structure has shown it to be complex in shape and changed the earlier notion, derived from two‐dimensional echocardiography, that the aortic annulus and left ventricular outflow tract (LVOT) were both circular in outline.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, precise cardiac imaging modalities have become the backbone in the pre-TAVR evaluation. [4][5][6][7][8][9] Recent advances in our knowledge of aortic root structure has shown it to be complex in shape and changed the earlier notion, derived from two-dimensional echocardiography, that the aortic annulus and left ventricular outflow tract (LVOT) were both circular in outline. Consequently, two-dimensional echocardiography is insufficiently able to define the accurate prosthesis size.…”

Section: Introductionmentioning

confidence: 99%

“…There is no worldwide consensus regarding which cardiac imaging modality is the best for aortic annular sizing in pre-TAVR evaluation. 4,9,[19][20][21][22] Observational studies have been performed to compare 3D transesophageal echocardiography (3DTEE) with MDCT for annular sizing. This stems from the fact that contrast used in MDCT in pre-TAVR aortic annulus sizing can induce kidney injury in as many as 7% to 10.5% of patients and the risk of this complication is much higher if the patient has pre-existing renal impairment.…”

Section: Introductionmentioning

confidence: 99%

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Three‐dimensional transesophageal echocardiography is an attractive alternative to cardiac multi‐detector computed tomography for aortic annular sizing: Systematic review and meta‐analysis

et al. 2018

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Background Cardiac imaging is the cornerstone of the pretranscatheter aortic valve replacement (TAVR) assessment. Multi‐detector computed tomography (MDCT) is considered the conventional imaging modality. However, there is still no definitive gold standard. Targeted cohort of inoperable high‐risk patients with underlying comorbidities, particularly renal impairment, makes apparent the need for MDCT alternative. We aimed to demonstrate the correlation extent between MDCT and three‐dimensional transesophageal echocardiography (3DTEE) aortic annular area measures and to answer the question: Is 3DTEE a good alternative to MDCT? Methods A systematic literature search and meta‐analysis were conducted to evaluate the degree of correlation and agreement between 3DTEE and MDCT aortic annular sizing. A thorough assessment of EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. All studies comparing 3DTEE and MDCT in relation to aortic annular sizing were included. Results Thirteen studies were included (N = 1228 patients). A strong linear correlation was found between 3DTEE and MDCT measurements of aortic annulus area (r = 0.84, P < 0.001), mean perimeter (r = 0. 0.85, P < 0.001), and mean diameter (r = 0.80, P < 0.001). Bland–Altman plots revealed smaller mean 3DTEE values in comparison to MDCT for aortic annular area, the mean difference being −2.22 mm2 with 95% limits of agreement −12.79 to 8.36. Conclusion Aortic annulus measurements obtained by 3DTEE demonstrated a high level of correlation with those evaluated by MDCT. This makes 3DTEE a feasible choice for aortic annulus assessment, with advantage of real time assessment, lack of contrast, and no radiation exposure.

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Role of Echocardiography Before Transcatheter Aortic Valve Implantation (TAVI)

Cited by 11 publications

References 83 publications

Aortic Stenosis, a Left Ventricular Disease: Insights from Advanced Imaging

Aortic Stenosis, a Left Ventricular Disease: Insights from Advanced Imaging

Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach

Three‐dimensional transesophageal echocardiography is an attractive alternative to cardiac multi‐detector computed tomography for aortic annular sizing: Systematic review and meta‐analysis

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