Automated quantification of mitral valve geometry on multi-slice computed tomography in patients with dilated cardiomyopathy – Implications for transcatheter mitral valve replacement

Banks, Tom; Razeghi, Orod; Ntalas, Ioannis; Aziz, Waqar; Behar, Jonathan M.; Preston, Rebecca; Campbell, Brian; Redwood, Simon; Prendergast, Bernard; Niederer, Steven A.; Rajani, Ronak

doi:10.1016/j.jcct.2018.04.003

Cited by 14 publications

(12 citation statements)

References 26 publications

(41 reference statements)

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“…The mitral valve is a complex structure with a three-dimensional saddle shaped annulus. [25][26][27] CT can provide high-resolution, three-dimensional data for the evaluation of the mitral annulus including adjacent structures such as the circumflex artery and represents the imaging modality of choice for the evaluation of distribution and extent of MAC. 25,28 Quantitative evaluation of coronary artery and aortic valve calcifications on CT images with dedicated software platforms are easy to perform and are highly reproducible.…”

Section: Tablementioning

confidence: 99%

Mitral annular calcification in the elderly – Quantitative assessment

Eberhard

Schönenberger

Hinzpeter

et al. 2021

Journal of Cardiovascular Computed Tomography

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To determine the reliability of subjective and objective quantification of mitral annular calcification (MAC) in elderly patients with severe aortic stenosis, to define quantitative sex-and age-related reference values of MAC, and to correlate quantitative MAC with mitral valve disease. Methods: In this retrospective, IRB-approved study, we included 559 patients (268 females, median age 81 years, inter-quartile range 77-85 years) with severe aortic stenosis undergoing CT. Four independent readers performed subjective MAC categorization as follows: no, mild, moderate, and severe MAC. Two independent readers performed quantitative evaluation of MAC using the Agatston score method (Agatston MAC). Mitral valve disease was determined by echocardiography. Results: Subjective MAC categorization showed high inter-reader agreement for no (k = 0.88) and severe MAC (k = 0.75), whereas agreement for moderate (k = 0.59) and mild (k = 0.45) MAC was moderate. Intra-reader agreement for subjective MAC categorization was substantial (k = 0.69 and 0.62). Inter-and intra-reader agreement for Agatston MAC were excellent (ICC = 0.998 and 0.999, respectively), with minor inconsistencies in MAC involving the left ventricular outflow tract/aortic valve. There were significantly more women than men with MAC (n = 227, 85% versus n = 209, 72%; p < 0.001), with a significantly higher Agatston MAC (median 597, range 81-2055 versus median 244; range 0-1565; p < 0.001), particularly in patients ≥85 years of age. Agatston MAC showed an area-under-the-curve of 0.84 to diagnose mitral stenosis, whereas there was no association of Agatston MAC with mitral regurgitation (p > 0.05). Conclusions: Our study in elderly patients with severe aortic stenosis shows that quantitative MAC scoring is more reliable than subjective MAC assessment. Women show higher Agatston MAC scores than men, particularly in the elderly population. Agatston MAC shows high accuracy to diagnose mitral stenosis.

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Section: Tablementioning

confidence: 99%

Mitral annular calcification in the elderly – Quantitative assessment

Eberhard

Schönenberger

Hinzpeter

et al. 2021

Journal of Cardiovascular Computed Tomography

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“…Tracking motion can essentially be defined as the nonrigid registration of image sequences. To track the LV endocardium motion, we used an intensity‐based temporal sparse free‐form deformation registration algorithm 14 with its hyperparameters optimised to minimise a cost function defined as the mean squared error of tracking manually annotated landmarks 15 . This provided us with a smooth deformation field in space and time.…”

Section: Methodsmentioning

confidence: 99%

Tracking the motion of intracardiac structures aids the development of future leadless pacing systems

Razeghi

Strocchi

Lee

et al. 2020

Cardiovasc electrophysiol

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Background Leadless pacemakers preclude the need for permanent leads to pace endocardium. However, it is yet to be determined whether a leadless pacemaker of a similar design to those manufactured for the right ventricle (RV) fits within the left ventricle (LV), without interfering with intracardiac structures. Methods Cardiac computed tomography scans were obtained from 30 patients indicated for cardiac resynchronisation therapy upgrade. The mitral valve annulus, chordae tendineae, papillary muscles and LV endocardial wall were marked in the end‐diastolic frame. Intracardiac structures motions were tracked through the cardiac cycle. Two pacemaker designs similar to commercially manufactured leadless systems (Abbott's Nanostim LCP and Medtronic's Micra TPS) as well as theoretical designs with calculated optimal dimensions were evaluated. Pacemakers were virtually placed across the LV endocardial surface and collisions between them and intracardiac structures were detected throughout the cycle. Results Probability maps of LV intracardiac structures collisions on a 16‐segment AHA model indicated possible placement for the Nanostim LCP, Micra TPS, and theoretical designs. Thresholding these maps at a 20% chance of collision revealed only about 36% of the endocardial surface remained collision‐free with the deployment of Micra TPS design. The same threshold left no collision‐free surface in the case of the Nanostim LCP. To reach at least half of the LV endocardium, the volume of Micra TPS, which is the smaller design, needed to be decreased by 41%. Conclusion Due to the presence of intracardiac structures, placement of leadless pacemakers with dimensions similar to commercially manufactured RV systems would be limited to apical regions.

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“…The semilunar cross-sectional area of the neo-LVOT may be measured by planimetry. Since LVOT obstruction may have profound hemodynamic consequences, several methods have been proposed to predict the risk of this complication, including proprietary software (11,(24)(25)(26). Predictors of LVOT obstruction can be identified by CT, TTE or TEE: aortomitral angle <110°, LVOT area <2.0 cm 2 , length of the AML, short chordae, direct papillary muscle attachment, thickness of the basal segment of the interventricular septum and LV cavity size.…”

Section: Mitral Valve Imaging-multimodality Approachmentioning

confidence: 99%

“…(IV) TMVR relies on both echocardiography and CT, which are critical for patient selection, complete anatomic definition of the mitral complex, prediction of LVOT obstruction and complications diagnosis. Echocardiography is essential for procedural guidance (18,19,21,24,26,(33)(34)(35).…”

Section: Mitral Valve Technologies-imaging Challenges and Practical Usementioning

confidence: 99%

Role of imaging in novel mitral technologies—echocardiography and computed tomography

Loghin¹,

Loghin²

2018

Ann. Cardiothorac. Surg.

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As minimally invasive cardiovascular procedures gain popularity, novel transcatheter mitral valve repair devices continue to emerge. The success of these technologies is critically dependent on high quality imaging performed at all stages: patient selection, intervention planning, intraprocedural guidance, monitoring complications and follow-up. We present an overview of specific imaging requirements and challenges applicable to mitral valve interventional techniques. Modern valve imaging is multimodal and primarily combines echocardiography and computed tomography (CT). Echocardiography remains the gold standard for detailed anatomic imaging, complete hemodynamic characterization and real-time guidance and evaluation of procedural success. CT is indispensable for mitral annulus (MA) imaging and in predicting left ventricular outflow tract (LVOT) obstruction post transcutaneous mitral valve replacement (TMVR). 3D modeling, fusion imaging and automated image analysis may further contribute to the evolutionary transformation of valvular heart imaging.

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Automated quantification of mitral valve geometry on multi-slice computed tomography in patients with dilated cardiomyopathy – Implications for transcatheter mitral valve replacement

Abstract: Variability of mitral valve annulus measurements are small during the cardiac cycle. Novel automated algorithms to determine cardiac cycle variations in mitral valve geometry may offer improved segmentation accuracy as well as improved CT interpretation times.

Cited by 14 publications

References 26 publications

Mitral annular calcification in the elderly – Quantitative assessment

Mitral annular calcification in the elderly – Quantitative assessment

Tracking the motion of intracardiac structures aids the development of future leadless pacing systems

Role of imaging in novel mitral technologies—echocardiography and computed tomography

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