A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement
Introduction: Accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (TAVR) procedure. While computed tomography angiography (CTA) is the widely-accepted standard, two-dimensional (2D) and three-dimensional(3D) transesophag...
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| Format: | Article |
| Language: | English |
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Tabriz University of Medical Sciences
2021-08-01
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| Series: | Journal of Cardiovascular and Thoracic Research |
| Subjects: | |
| Online Access: | https://jcvtr.tbzmed.ac.ir/PDF/jcvtr-13-208.pdf |
| _version_ | 1818728870158794752 |
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| author | Siddarth Singh Piotr S. Rutkowski Alexey Dyachkov Vijay S. Iyer Leili Pourafkari Nader D. Nader |
| author_facet | Siddarth Singh Piotr S. Rutkowski Alexey Dyachkov Vijay S. Iyer Leili Pourafkari Nader D. Nader |
| author_sort | Siddarth Singh |
| collection | DOAJ |
| description | Introduction: Accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (TAVR) procedure. While computed tomography angiography (CTA) is the widely-accepted standard, two-dimensional (2D) and three-dimensional(3D) transesophageal echocardiography (TEE) is commonly performed to measure the size of the aortic valve and to verify appropriate seating of prostheses. Methods: Patients undergoing TAVR between 2013-2015 were examined. 2D- and 3D-TEEmeasurements were compared to CTA taken as standard. Patients were followed for at least one year. The presence and effect of discrepancy (defined as a difference of more than 10%) between CTA and TEE measurements on survival were examined. Results: One hundred eighty-five patients (70 men) were included. 2D- and 3D-TEE measurements underestimated the annulus size by -1.49 and -1.32 mm, respectively. Discrepancies > 10% between TEE and CTA methods in estimating the aortic annulus size were associated with a decrease in post implant survival. The peak pressure gradient across the aortic prosthesis measured one year after the implant was higher in patients with an initial discrepancy between 3D-TEE and CTA measurements. In a multivariate cox-regression model, the discrepancy between CTA and 2D-TEE readings and the smaller size of the aortic annular area were the predictors of long-term survival. Conclusion: Both 2D and 3D-TEE underestimate the aortic annulus measurements compared to CTA, with 2D-TEE being relatively more precise than 3D-TEE technology. The presence of a discrepancy between echocardiographic and CTA measurements of the aortic annulus is associated with a lower survival rate. |
| first_indexed | 2024-12-17T22:36:51Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2008-5117 2008-6830 |
| language | English |
| last_indexed | 2024-12-17T22:36:51Z |
| publishDate | 2021-08-01 |
| publisher | Tabriz University of Medical Sciences |
| record_format | Article |
| series | Journal of Cardiovascular and Thoracic Research |
| spelling | doaj.art-d4f6d21f84c541728e9b6b3b363eaf2f2022-12-21T21:30:04ZengTabriz University of Medical SciencesJournal of Cardiovascular and Thoracic Research2008-51172008-68302021-08-0113320821510.34172/jcvtr.2021.39jcvtr-28771A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacementSiddarth Singh0Piotr S. Rutkowski1Alexey Dyachkov2Vijay S. Iyer3Leili Pourafkari4Nader D. Nader5Department of Anesthesiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USADepartment of Anesthesiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USADepartment of Anesthesiology, Geisinger Medical Center, Danville, PA, USAGates Vascular Institute, Interventional Cardiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USACatholic Health System, University at Buffalo Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY, USADepartment of Anesthesiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USAIntroduction: Accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (TAVR) procedure. While computed tomography angiography (CTA) is the widely-accepted standard, two-dimensional (2D) and three-dimensional(3D) transesophageal echocardiography (TEE) is commonly performed to measure the size of the aortic valve and to verify appropriate seating of prostheses. Methods: Patients undergoing TAVR between 2013-2015 were examined. 2D- and 3D-TEEmeasurements were compared to CTA taken as standard. Patients were followed for at least one year. The presence and effect of discrepancy (defined as a difference of more than 10%) between CTA and TEE measurements on survival were examined. Results: One hundred eighty-five patients (70 men) were included. 2D- and 3D-TEE measurements underestimated the annulus size by -1.49 and -1.32 mm, respectively. Discrepancies > 10% between TEE and CTA methods in estimating the aortic annulus size were associated with a decrease in post implant survival. The peak pressure gradient across the aortic prosthesis measured one year after the implant was higher in patients with an initial discrepancy between 3D-TEE and CTA measurements. In a multivariate cox-regression model, the discrepancy between CTA and 2D-TEE readings and the smaller size of the aortic annular area were the predictors of long-term survival. Conclusion: Both 2D and 3D-TEE underestimate the aortic annulus measurements compared to CTA, with 2D-TEE being relatively more precise than 3D-TEE technology. The presence of a discrepancy between echocardiographic and CTA measurements of the aortic annulus is associated with a lower survival rate.https://jcvtr.tbzmed.ac.ir/PDF/jcvtr-13-208.pdfaortic stenosiscomputed tomographicangiographyechocardiographytrans-catheter aortic valvereplacement |
| spellingShingle | Siddarth Singh Piotr S. Rutkowski Alexey Dyachkov Vijay S. Iyer Leili Pourafkari Nader D. Nader A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement Journal of Cardiovascular and Thoracic Research aortic stenosis computed tomographic angiography echocardiography trans-catheter aortic valve replacement |
| title | A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement |
| title_full | A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement |
| title_fullStr | A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement |
| title_full_unstemmed | A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement |
| title_short | A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement |
| title_sort | discrepancy between ct angiography and transesophageal echocardiographic measurements of the annular size affect long term survival following trans catheter aortic valve replacement |
| topic | aortic stenosis computed tomographic angiography echocardiography trans-catheter aortic valve replacement |
| url | https://jcvtr.tbzmed.ac.ir/PDF/jcvtr-13-208.pdf |
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