Key result
Max-systolic measurements of the aortic root were significantly larger than end-diastolic and non-ECG-synchronized measurements (p<0.001), resulting in the same theoretical prosthesis size selection in only 48-62% of patients.
Why the study?
No consensus exists on the optimal pre-procedural MDCT protocol for TAVI, and acquisition protocol variability may cause discrepancies in aortic annulus measurements and influence prosthesis sizing.
Does retrospectively ECG-gated CTA (max-systolic vs end-diastolic) compared to non-ECG-synchronized high-pitch CTA affect aortic annulus measurements and prosthesis size selection in TAVI candidates?
Observational (n=50)
Single-blind
No
Does retrospectively ECG-gated CTA (max-systolic vs end-diastolic) compared to non-ECG-synchronized high-pitch CTA affect aortic annulus measurements and prosthesis size selection in TAVI candidates?
p-value: p=<0.001
Systolic image acquisition during ECG-gated CTA is necessary for accurate assessment of maximal annular dimensions in TAVI planning, as non-ECG-synchronized or end-diastolic imaging alters prosthesis size selection in nearly half of patients.
Protocol variability in pre-TAVI MDCT was associated with annulus measurement differences; leaves open optimal imaging standardization.
BACKGROUND: Multidetector computed tomography (MDCT) plays a key role in patient assessment prior to transcatheter aortic valve implantation (TAVI). However, to date no consensus has been established on what is the optimal pre-procedural imaging protocol. Variability in pre-TAVI acquisition protocols may lead to discrepancies in aortic annulus measurements and may potentially influence prosthesis size selection. PURPOSE: The current study evaluates the magnitude of differences in aortic annulus measurements using max-systolic, end-diastolic, and non-ECG-synchronized imaging, as well as the impact of method on prosthesis size selection. MATERIAL AND METHODS: Fifty consecutive TAVI-candidates, who underwent retrospectively-ECG-gated CT angiography (CTA) of the aortic root, directly followed by non-ECG-synchronized high-pitch CT of the entire aorta, were retrospectively included. Aortic root dimensions were assessed at each 10% increment of the R-R interval (0-100%) and on the non-ECG-synchronized scan. Dimensional changes within the cardiac cycle were evaluated using a 1-way repeated ANOVA. Agreement in measurements between max-systole, end-diastole and non-ECG-synchronized scans was assessed with Bland-Altman analysis. RESULTS: Maximal dimensions of the aortic root structures and minimum annulus-coronary ostia distances were measured during systole. Max-systolic measurements were significantly and substantially larger than end-diastolic (p<0.001) and non-ECG-synchronized measurements (p<0.001). Due to these discrepancies, the three methods resulted in the same prosthesis size selection in only 48-62% of patients. CONCLUSIONS: The systematic differences between max-systolic, end-diastolic and non-ECG-synchronized measurements for relevant aortic annular dimensions are both statistically significant and clinically relevant. Imaging strategy impacts prosthesis size selection in nearly half the TAVI-candidates. End-diastolic and non-ECG-synchronized imaging does not provide optimal information for prosthesis size selection. Systolic image acquisition is necessary for assessment of maximal annular dimensions and minimum annulus-coronary ostia distances.
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Horehledova et al. (2020) conducted an observational in Severe and symptomatic aortic valve stenosis (n=50). Max-systolic retrospectively ECG-gated CTA vs. End-diastolic and non-ECG-synchronized high-pitch CTA was evaluated on Aortic annulus measurements (p=<0.001). Max-systolic measurements of the aortic root were significantly larger than end-diastolic and non-ECG-synchronized measurements (p<0.001), resulting in the same theoretical prosthesis size selection in only 48-62% of patients.
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