Clinical Research
Automated 3-Dimensional Aortic Annular Assessment by Multidetector Computed Tomography in Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.jcin.2013.05.008Get rights and content
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Objectives

This study sought to evaluate the accuracy, reproducibility, and predictive value for post-procedural aortic regurgitation (AR) of an automated multidetector computed tomography (MDCT) post-processing imaging software, 3mensio Valves (version 5.1.sp1, 3mensio Medical Imaging BV, the Netherlands), in the assessment of patients undergoing transcatheter aortic valve implantation (TAVI).

Background

Accurate pre-operative aortic annulus measurements are crucial for patients undergoing TAVI.

Methods

One hundred five patients undergoing MDCT screening before TAVI were evaluated. Aortic annular measurement was compared between automated 3mensio Valves software and manual data post-processing software on a dedicated workstation; we analyzed the discrimination value of annulus measurement for post-procedural AR in 44 recipients of a self-expanding valve.

Results

The automated 3mensio Valves software showed good concordance with manual MDCT measurements as demonstrated by Bland-Altman analysis. The automated software provided equally good reproducibility as manual measurement, especially for measurement of aortic annulus area (intraobserver intraclass correlation coefficients 0.98 vs. 0.97, interobserver 0.98 vs. 0.95). In 44 patients after implantation of a self-expanding valve, the valve diameter/CT-measured geometric mean annulus diameter ratio by automated 3mensio Valves software showed moderate and better discrimination ability in predicting post-procedural AR compared with manual measurement (p = 0.12, area under the curve 0.77, 95% confidence interval: 0.63 to 0.91, area under the curve 0.68, 95% confidence interval: 0.50 to 0.86, respectively).

Conclusions

The automated 3mensio Valves software demonstrated reliable, reproducible aortic annulus measurement and better predictive value for post-procedural AR, suggesting important clinical implications for pre-operative assessment of patients undergoing TAVI.

Key Words

annulus measurement
multidetector computed tomography
transcatheter aortic valve implantation

Abbreviations and Acronyms

AR
aortic regurgitation
AS
aortic stenosis
AUC
area under the curve
CI
confidence interval
ICC
intraclass correlation coefficient
MDCT
multidetector computed tomography
mDiam-CT
geometric mean annulus diameter measured by computed tomography
lDiam-CT
long-axis annulus diameter measured by computed tomography
sDiam-CT
short-axis annulus diameter measured by computed tomography
ROC
receiver-operating characteristic
TAVI
transcatheter aortic valve implantation
TEE
transesophageal echocardiography

Cited by (0)

Drs. Hayashida and Romano are proctors for transfemoral-TAVI for Edwards Lifesciences. Dr. Romano is a proctor for transapical-TAVI for Edwards Lifesciences. Dr. Lefèvre is a proctor for transfemoral-TAVI for Edwards; has received minor fees from Boston Scientific and Direct Flow Medical; and is a consultant for Symetis and Direct Flow Medical. Dr. Chevalier is a consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.