Key result
A novel 2D-TEE circumcircle of a triangle method for aortic annular sizing yielded areas on average 42.33 mm2 higher than CT, but demonstrated good overall agreement for valve size selection (kappa = 0.67).
Why the study?
Does 2D-TEE using the circumcircle of a triangle method accurately measure aortic annulus dimensions compared to CT in patients undergoing TAVI?
Observational (n=63)
Single-blind
No
Does 2D-TEE using the circumcircle of a triangle method accurately measure aortic annulus dimensions compared to CT in patients undergoing TAVI?
Mean Difference: 42.33
Absolute Event Rate: 495.6% vs 453.3%
p-value: p=<0.001
A novel 2D-TEE method for aortic annulus sizing shows good agreement with CT for TAVI prosthesis selection, although CT remains the gold standard.
May aid annular sizing when CT unavailable; leaves open need for outcome validation in larger cohorts.
BACKGROUND: Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI). In this study we examined the accuracy of a novel method using two-dimensional transesophageal echocardiography (2D-TEE) for measurement of the aortic annulus. METHODS: We evaluated the theoretical impact of the measurement of the annulus diameter and area using the circumcircle of a triangle method on the decision to perform the procedure and choice of the prosthesis size. RESULTS: Sixty-three consecutive patients were scheduled for TAVI. Mean age was 82 ± 4 years, and 25 patients (55.6 %) were female. Mean aortic annulus diameter was 20.3 ± 2.2 mm assessed by TEE on the mid-esophageal long-axis view and 23.9 ± 2.3 mm using CT (p < 0.001). There was a tendency for the TEE derived areas using the new method to be higher (p < 0.001). The TEE measurements were on average 42.33 mm(2) higher than the CT measurements without an evidence of a systematic over- or under-sizing (p = 1.00). Agreement between TEE and CT chosen valve sizes was good overall (kappa = 0.67 and weighted kappa = 0.71). For patients who turned out to have no AR, the two methods agreed in 84.6 % of patients. CONCLUSIONS: CT remanis the gold standard in sizing of the aortic valve annulus. Nevertheless, sizing of the aortic valve annulus using TEE derived area may be helpful. The impact of integration of this method in the algorithm of aortic annulus sizing on the outcome of patients undergoing TAVI should be examined in future studies.
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Sherif et al. (2015) conducted an observational in Severe symptomatic tricuspid aortic stenosis (n=63). 2D-TEE circumcircle of a triangle method vs. Multidetector computed tomography (CT) was evaluated on Aortic annulus area measurement (MD 42.33, p=<0.001). A novel 2D-TEE circumcircle of a triangle method for aortic annular sizing yielded areas on average 42.33 mm2 higher than CT, but demonstrated good overall agreement for valve size selection (kappa = 0.67).
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