Assessment of the aortic annulus by multislice computed tomography, contrast aortography, and trans-thoracic echocardiography in patients referred for transcatheter aortic valve implantation

Objective: We sought to determine the level of agreement and the reproducibility of trans‐thoracic echocardiography (TTE), contrast aortography (CA) and multislice computed tomography (MSCT) for the assessment of the aortic annulus, in patients referred for Transcatheter Aortic Valve Implantation (T...

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Published in:	Catheterization and cardiovascular interventions Vol. 77; no. 6; pp. 868 - 875
Main Authors:	Tzikas, Apostolos, Schultz, Carl J., Piazza, Nicolo, Moelker, Adrian, Van Mieghem, Nicolas M., Nuis, Rutger-Jan, van Geuns, Robert-Jan, Geleijnse, Marcel L., Serruys, Patrick W., de Jaegere, Peter P.T.
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-05-2011
Subjects:	Aged, 80 and over Aorta Aortic valve Aortic Valve - diagnostic imaging Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - therapy Aortography - methods Cardiac Catheterization - adverse effects Cardiac Catheterization - instrumentation Catheterization Computed tomography Contrast Media Echocardiography Female Heart Valve Prosthesis Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - instrumentation Heart Valve Prosthesis Implantation - methods Humans imaging Linear Models Male Netherlands Observer Variation Predictive Value of Tests Prosthesis Design Referral and Consultation Regression analysis Reproducibility of Results Severity of Illness Index Stenosis Tomography, X-Ray Computed valves
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Summary:	Objective: We sought to determine the level of agreement and the reproducibility of trans‐thoracic echocardiography (TTE), contrast aortography (CA) and multislice computed tomography (MSCT) for the assessment of the aortic annulus, in patients referred for Transcatheter Aortic Valve Implantation (TAVI). Background: Correct measurement of the aortic annulus is important for TAVI. Methods: The dimensions of the aortic annulus were measured using TTE, CA and MSCT in 70 patients with severe aortic stenosis, referred for TAVI. Agreement between imaging techniques and interobserver variability was assessed using the Bland ‐ Altman method and a linear regression model. Results: The MSCT Coronal view provided the largest mean annulus diameter (26.3 mm) followed by CA (24.4 mm), MSCT Mean (23.7 mm), TTE (22.6 mm), and MSCT Sagittal (21.8 mm) view. Differences in the annulus measurements were significant: MSCT Coronal view versus CA (mean, 95% confidence interval, Pearson's correlation) 2.0 mm, −1.9 to 6.0 mm, r = 0.72, CA versus MSCT Mean 0.2 mm, −3.3 to 3.7 mm, r = 0.76, MSCT Mean versus TTE 1.3 mm, −2.9 to 5.5 mm, r = 0.61, TTE versus MSCT Sagittal view 0.9 mm, −3.6 to 5.4 mm, r = 0.59, CA versus TTE 1.5 mm, −3.0 to 5.9 mm, r = 0.57. Interobserver variability was: TTE (mean, 95% confidence interval, Pearson's correlation) 0.29 mm, −4.2 to 4.8 mm, r = 0.57, CA 0.14 mm, −3.5 to 3.8 mm, r = 0.77, MSCT Mean 0.20 mm, −1.4 to 1.8 mm, r = 0.95. Conclusions: We found significant differences in the dimensions of the aortic annulus measured by MSCT, CA, and TTE. Interobserver variability for TTE and CA was substantially higher compared with MSCT. © 2011 Wiley‐Liss, Inc.
Bibliography:	ark:/67375/WNG-B1ZXR1GT-G European Association of Percutaneous Cardiovascular Interventions (EAPCI Interventional Cardiology Research Grant 2009) provided Dr. Tzikas with support. Conflict of interest: Nothing to report. ArticleID:CCD22761 istex:D3CA6361A6DD9B6B1E729EB629860D4CADD90E0F ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	1522-1946 1522-726X 1522-726X
DOI:	10.1002/ccd.22761