Key result
After excluding patients with hypo-attenuated leaflet thickening, the incidence of severe patient-prosthesis mismatch after TAVI was very low at 0.5% using CT angiography compared to 4.5% using echocardiography.
Why the study?
Assessment of PPM after TAVI using TTE and presence of HALT may lead to overestimation.
Does CTA assessment compared to TTE assessment change the detected incidence of patient-prosthesis mismatch in patients after TAVI?
Observational (n=444)
No
Does CTA assessment compared to TTE assessment change the detected incidence of patient-prosthesis mismatch in patients after TAVI?
CT-based assessment of patient-prosthesis mismatch after TAVI yields a much lower incidence of severe PPM compared to TTE, and smaller EOA did not influence overall survival.
Answers are grounded in this paper and cite their sources.
CT detects far fewer severe PPM cases than TTE after TAVI; leaves open whether CT should replace TTE for mismatch evaluation.
BACKGROUND: Patient-prosthesis mismatch (PPM) after trans-catheter aortic valve implantation (TAVI) is a risk factor for heart failure and mortality. Assessment of PPM using transthoracic echocardiography (TTE) and presence of hypo-attenuated leaflet thickening (HALT) may lead to overestimation. Our study aimed to assess the incidence of PPM using TTE and CTA after exclusion of patients with HALT and to evaluate predictors analyzing stent geometry. METHODS: 444 patients were analyzed. PPM was calculated using the continuity equation from TTE (TTE-PPM) and CTA (CT-PPM). Regression analyses were conducted for the endpoint effective orifice area (EOA) as surrogate for PPM. RESULTS: Severe PPM was detected in 4.5% using TTE-PPM and in 0.5% using CT-PPM. Body mass index (BMI) was identified as a predictor for a smaller EOA in each model (p < 0.001). Using TTE-PPM and CT-PPM, a smaller valve diameter was associated with a smaller effective orifice area (EOA) (p < 0.001). Presence of a balloon-expanding valve was associated with a smaller EOA using CT-PPM (p = 0.033). Stent geometry did not influence the EOA (p > 0.05 each model). EOA did not influence overall survival (p > 0.05 each model). CONCLUSIONS: The incidence of severe PPM was very low and only predicted by BMI in each assessment model. Stent geometry did not influence the incidence of PPM. Overall survival was not influenced by a smaller EOA.
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Schmitt et al. (2025) conducted an observational in Patient-prosthesis mismatch after transcatheter aortic valve implantation (n=444). Computed tomography angiography (CTA) for PPM assessment vs. Transthoracic echocardiography (TTE) for PPM assessment was evaluated on Incidence of severe patient-prosthesis mismatch (PPM). After excluding patients with hypo-attenuated leaflet thickening, the incidence of severe patient-prosthesis mismatch after TAVI was very low at 0.5% using CT angiography compared to 4.5% using echocardiography.
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