Key result
CT-derived LVOT diameter reclassifies AS severity in ~12% of TAVI candidates, especially with suboptimal echo.
Why the study?
Transthoracic echocardiography can underestimate LVOT diameter and cause discordant aortic stenosis grading when image quality is suboptimal, leaving uncertain whether substituting routine pre-TAVI CT-derived LVOT diameter into the continuity equation improves grading.
Does incorporating CT-derived LVOT diameter into the continuity equation to calculate indexed aortic valve area improve aortic stenosis grading compared with echocardiography-derived indexed aortic valve area in TAVI candidates?
Observational (n=426)
Does incorporating CT-derived LVOT diameter into the continuity equation to calculate indexed aortic valve area improve aortic stenosis grading compared with echocardiography-derived indexed aortic valve area in TAVI candidates?
Incorporating CT-derived LVOT diameter into the continuity equation reclassifies 12% of TAVI candidates to less severe aortic stenosis, predominantly among those with suboptimal echocardiographic image quality and normal-flow, low-gradient AS.
Background Transthoracic echocardiography (TTE) can underestimate left ventricular outflow tract (LVOT) diameter (LVOTdECHO) leading to discordant aortic stenosis (AS) grading, particularly in patients with suboptimal image quality. Cardiac computed tomography (CT), routinely performed before transcatheter aortic valve implantation (TAVI) allows accurate LVOT assessment. Our aim was to assess whether inserting CT-derived LVOT diameter (LVOTdCT) into the continuity equation to calculate indexed AVA (AVAi_CT), improves AS grading compared with echocardiography-derived AVAi (AVAi_ECHO), particularly when echocardiographic image quality is suboptimal. Methods We retrospectively analyzed 426 TAVI candidates (82.3±7.3 years; 50.2% women) who underwent both CT and echocardiography. LVOTdCT was measured on a plane replicating the parasternal long-axis view and used to compute AVAi_CT. Image quality was graded (good/fair/poor). Reclassification was defined as AVAi_ECHO ≤0.6 cm²/m² and AVAi_CT >0.6 cm²/m². Association with echocardiographic parameters (dimensionless index, DI, acceleration time/ejection time, AT/ET) and CT-derived aortic valve calcium score (AVC) and annulus-indexed AVC (AVCdCT) were examined. Results LVOTdECHO were smaller than CT (median 2.0 [1.7–2.3] vs 2.2 [1.9–2.5] cm; p<0.001). Agreement declined with image quality (ICC good/fair/poor: 0.900/0.689/0.481). AVAi_CT exceeded AVAi_ECHO (0.82±0.22 vs 0.70±0.18 cm²/m²; p<0.001). Overall, 51/426 (12.0%) were reclassified, 82.4% of whom had fair/poor image quality (OR 5.508; 95% CI 2.6–11.6; p<0.001). Most reclassification occurred in normal-flow/low-gradient AS (38.1%). Reclassified patients had DI>0.25 (72.5% vs 20.2%; p<0.001), AT/ET≤0.32 (52.9% vs 38.5%; p=0.043), and lower AVC/AVCdCT. Conclusions Incorporating LVOTdCT into the continuity equation improves AS grading, particularly in normal-flow, low-gradient AS patients and suboptimal echocardiographic quality, and may refine TAVI selection.
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Beneki et al. (2026) conducted an observational in Aortic stenosis in TAVI candidates (n=426). CT-derived LVOT diameter (LVOTdCT) incorporated into the continuity equation (AVAi_CT) vs. Echocardiography-derived indexed aortic valve area (AVAi_ECHO) was evaluated on Reclassification of aortic stenosis severity (defined as AVAi_ECHO ≤0.6 cm²/m² and AVAi_CT >0.6 cm²/m²) (OR 5.508, 95% CI 2.6-11.6, p=<0.001). CT-derived LVOT diameter reclassified aortic stenosis severity in 12.0% of TAVI candidates, predominantly in those with fair/poor echo quality (OR 5.508; 95% CI 2.6-11.6; p<0.001).
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