Impact of Three‐Dimensional Imaging and Pressure Recovery on Echocardiographic Evaluation of Severe Aortic Stenosis: A Pilot Study

Stähli, Barbara E.; Abouelnour, Amr; Nguyen, Thai; Vecchiati, Alessandra; Maier, Willibald; Lüscher, Thomas F.; Frauenfelder, Thomas; Tanner, Felix C.

doi:10.1111/echo.12509

Cited by 14 publications

(16 citation statements)

References 40 publications

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“…The concept of elliptical LVOT demonstrated to have clinical implications in aortic valve stenosis evaluation, performed either with 3D echocardiography or CT or MR imaging. In fact, the aortic valve area calculated accounting for LVOT ellipticity was closer to the area calculated at catheterization and would reclassify severe aortic stenosis as moderate . In the setting of TAVR with Edwards‐Sapien valve, Ng and coworkers demonstrated both at multislice CT and transesophageal 3D echocardiography (3D TEE) that TAVR preserved, although slightly reduced, the ellipticity index of LVOT, which was in the same order of magnitude as in our study (1.20 by CT, 1.19 by 3DTEE).…”

Section: Discussionsupporting

confidence: 80%

Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis

et al. 2017

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Section: Discussionsupporting

confidence: 80%

Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis

et al. 2017

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“…This is done by obtaining the LVOT diameter (D1) from the parasternal long‐axis view as measured from the inner edge to the inner edge within 0.3–1 cm below the aortic valve annulus and then applying the formula LVOT Area = π ( D /2) 2 , assuming a circular shape of the LVOT. However, 3D imaging techniques have shown that this shape is often elliptical, and only rarely circular . This leads to underestimation of LVOT area, and hence of AVA, by the CE.…”

Section: Introductionmentioning

confidence: 99%

Aortic valve area using computed tomography‐derived correction factor to improve the validity of left ventricular outflow tract measurements

2020

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Aims Given the inherent inaccuracies stemming from the assumption that the left ventricular outflow tract (LVOT) is circular, this study aimed to improve the accuracy of transthoracic echocardiography (TTE)‐based aortic valve area (AVA) calculation using continuity equation (CE) by introducing a correction factor (CF) derived from multidetector computed tomography angiography (MDCTA) images and validate it in aortic stenosis (AS) patients. Methods and Results This retrospective study used MDCTA images of 400 patients for modeling and 403 TTE dataset for validation. Echocardiographic parasternal long‐axis view was modeled using MDCTA, and LVOT diameter (D1) was measured. Direct planimetry of LVOT area was performed and subsequently converted into a theoretical circle. The assumed circle (D2) diameter was derived, and D2/D1 was calculated and termed as the CF. The CF was 1.13, and it improved the agreement between MDCTA‐ and TTE‐derived LVOT areas and correlation between AVA and peak velocity, mean pressure gradient, and velocity ratio. In discordant subgroups of severe AS, the CF reclassified patients to moderate AS in 40% in the low flow (LF), low gradient (LG), and low ejection fraction (EF) group; 53% in the LF, LG, and normal EF group; and 68% in the LF, high gradient, and normal EF group. Conclusions CF of 1.13 derived from MDCTA improved the accuracy of TTE‐derived LVOT area and AVA and improved correlation with hemodynamic variables in AS patients. Reclassification of AS patients using CF may have clinical applicability for patient selection for early intervention.

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“…When ELI is not consistent with AVAI, other modalities should be used for severity assessment. Not only TTE but also TEE can be used to define ELI . ELI has been also shown to predict outcomes after AVR, and transcutaneous aortic valve replacement (TAVR) .…”

Section: Discrepancies In Echocardiographic Measurements Of Aortic Stmentioning

confidence: 99%

Evolving new concepts in the assessment of aortic stenosis

Deeprasertkul

Ahmad

2017

Echocardiography

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Echocardiography has been pivotal in evaluating aortic stenosis (AS) over the past several decades. Recent experience has shown a wide spectrum in the clinical presentation of AS. A better understanding of the underlying hemodynamic principles has resulted in emergence of new subtypes of AS. New treatment modalities have also been introduced, requiring precise evaluation of aortic valve (AV) pathology for implementation of these therapies. This review will discuss new concepts and indices in the use of echocardiography in patients with AS. Specifically, we will address the hemodynamic characteristics, clinical presentation, and management of normal-flow, high-gradient; paradoxical low-flow, low-gradient; and classical low-flow, low-gradient aortic stenoses.

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Impact of Three‐Dimensional Imaging and Pressure Recovery on Echocardiographic Evaluation of Severe Aortic Stenosis: A Pilot Study

Abstract: Three-dimensional TEE is more accurate than 2DTTE and 2DTEE for determining LVOT and AA dimensions. When AS severity is determined by 3DTEE and corrected for PR using the 3D values, it needs to be reclassified from severe to moderate in almost a third of patients.

Cited by 14 publications

References 40 publications

Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis

Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis

Aortic valve area using computed tomography‐derived correction factor to improve the validity of left ventricular outflow tract measurements

Evolving new concepts in the assessment of aortic stenosis

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