Key result
Energy loss index reclassifies ~43% of severe AS to moderate, associated with higher survival.
Why the study?
To assess whether combining TTE and MDCT data affects the grading of AS severity when considering the energy loss index in patients undergoing TAVR.
Does multimodality imaging derived energy loss index reclassify aortic stenosis severity and predict survival in patients undergoing TAVR?
Observational (n=197)
No
Does multimodality imaging derived energy loss index reclassify aortic stenosis severity and predict survival in patients undergoing TAVR?
Absolute Event Rate: 78.8% vs 67%
p-value: p=0.01
Integrating MDCT and TTE to calculate the energy loss index reclassifies a significant proportion of severe AS patients to moderate AS, which correlates with better mid-term survival after TAVR.
Multimodality ELI reclassifies many severe AS cases with better post-TAVR survival; hypothesis-generating and should not yet change practice.
AIMS: To assess whether the combination of transthoracic echocardiography (TTE) and multidetector computed tomography (MDCT) data affects the grading of aortic stenosis (AS) severity under consideration of the energy loss index (ELI) in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Multimodality imaging was performed in 197 patients with symptomatic severe AS undergoing TAVR at the University Hospital Zurich, Switzerland. Fusion aortic valve area index (fusion AVAi) assessed by integrating MDCT derived planimetric left ventricular outflow tract area into the continuity equation was significantly larger as compared to conventional AVAi (0.41 ± 0.1 vs. 0.51 ± 0.1 cm2/m2; P < 0.01). A total of 62 patients (31.4%) were reclassified from severe to moderate AS with fusion AVAi being >0.6 cm2/m2. ELI was obtained for conventional AVAi and fusion AVAi based on sinotubular junction area determined by TTE (ELILTL 0.47 ± 0.1 cm2/m2; fusion ELILTL 0.60 ± 0.1 cm2/m2) and MDCT (ELIMDCT 0.48 ± 0.1 cm2/m2; fusion ELIMDCT 0.61 ± 0.05 cm2/m2). When ELI was calculated with fusion AVAi the effective orifice area was >0.6 cm2/m2 in 85 patients (43.1%). Survival rate 3 years after TAVR was higher in patients reclassified to moderate AS according to multimodality imaging derived ELI (78.8% vs. 67%; P = 0.01). CONCLUSION: Multimodality imaging derived ELI reclassifies AS severity in 43% undergoing TAVR and predicts mid-term outcome.
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Holy et al. (2020) conducted an observational in Symptomatic severe aortic stenosis (n=197). Multimodality imaging derived energy loss index vs. Conventional echocardiography derived indices was evaluated on Survival rate at 3 years (p=0.01). Multimodality imaging derived energy loss index reclassified 43.1% of severe aortic stenosis patients to moderate, which was associated with higher 3-year survival (78.8% vs. 67%; P=0.01).
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