Aortic Annular Sizing Using a Novel 3-Dimensional Echocardiographic Method

Abstract

The goal of the current study is to compare a novel 3D-TEE method for annular assessment with MDCT measurements Background-Previous studies have shown cross-sectional 3-dimensional (3D) transesophageal echocardiographic (TEE) measurements to severely underestimate multidetector row computed tomographic (MDCT) measurements for the assessment of aortic annulus before transcatheter aortic valve replacement. This study compares annulus measurements from 3D-TEE using off-label use of commercially available software with MDCT measurements and assesses their ability to predict paravalvular regurgitation. Methods and Results-One hundred patients with severe, symptomatic aortic stenosis who had both contrast MDCT and 3D-TEE for annulus assessment before balloon-expandable transcatheter aortic valve replacement were analyzed. Annulus area, perimeter, and orthogonal maximum and minimum diameters were measured. Receiver operating characteristic analysis was performed with mild or greater paravalvular regurgitation as the classification variable. Three-dimensional TEE and MDCT cross-sectional perimeter and area measurements were strongly correlated (r=0.93-0.94; P<0.0001); however, the small differences (≤1%) were statistically significant (P=0.0002 and 0.0074, respectively). Discriminatory ability for ≥ mild paravalvular regurgitation was good for both MDCT (area under the curve for perimeter and area cover index=0.715 and 0.709, respectively) and 3D-TEE (area under the curve for perimeter and area cover index=0.709 and 0.694, respectively). Differences in receiver operating characteristic analysis between MDCT and 3D-TEE perimeter and area cover indexes were not statistically significant (P=0.15 and 0.35, respectively). Conclusions-Annulus

Three-Dimensional Echocardiography Compared With Computed Tomography to Determine Mitral Annulus Size Before Transcatheter Mitral Valve Implantation

“…27 This may be due in part to suboptimal lateral resolution in the coronal plane of 3D echocardiography, which reduces the ability to discriminate the blood/ tissue interface. 26 Nonetheless, this study demonstrated good agreement between MA dimensions derived by 3D-TEE and CT. The temporal resolution of the 3D TEE single beat 3D zoom acquisition was comparable to CT (6-9 Hz versus 7 Hz), making similar measurements possible between both modalities.…”

“…23,24 Therefore, it is imperative to have an alternative imaging strategy such as 3D-TEE which has become increasingly available in many institutions. Previous studies have demonstrated excellent correlation between 3D-TEE and CT measurements of the aortic annulus, 25,26 but this has not been verified for MA dimensions. Despite extensive literature describing the saddle-shaped annulus on 3D-TEE, our study is the first to report a 3D-TEE method that analyzes the MA as a D-shaped structure, an analysis which may be more relevant to TMVI sizing.…”

“…3DQ does not allow for a precise point by point marking of the MA in the long-axis plane rather only a direct perimeter trace in the short-axis view. Other annular measurements are also made directly onto the short-axis view not taking into account the true nonplanar configuration 3D echocardiography can underestimate measurements compared with other imaging modalities, such as CT 26 and magnetic resonance imaging. 27 This may be due in part to suboptimal lateral resolution in the coronal plane of 3D echocardiography, which reduces the ability to discriminate the blood/ tissue interface.…”

Relationship of Annular Sizing Using Multidetector Computed Tomographic Imaging and Clinical Outcomes After Self-Expanding CoreValve Transcatheter Aortic Valve Replacement

“…21,22 As a result, transcatheter valve selection based on 2-dimensional imaging has resulted in the selection of THVs that are relatively undersized to the true aortic annulus, 10 potentially resulting in postdeployment PVR. [7][8][9]13 Although 3-dimensional transesophageal echocardiography may provide a better estimate of the annular dimensions, 23 MDCT is now considered the reference standard for THV sizing for both the balloon-expandable 8,11 and self-expanding 15,24,25 designs. A number of parameters, including area, 8 mean diameter, 10,11 and perimeter, 6 have been used to estimate annular dimensions and to guide approximate THV sizing.…”

Multimodality Imaging in Transcatheter Mitral Interventions

“…1,2 Having 2 modalities capable of accurately measuring the same anatomic structure 3 has clinical utility. For instance, mandated MDCT annular measurements could not be performed accurately by the core laboratory in 6% to 8% of patients in the Placement of Aortic Transcatheter Valves II SAPIEN 3 trial 4 and thus required 3-dimensional (3D)-TEE for transcatheter valve sizing.…”