Improving the Accuracy of Effective Orifice Area Assessment after Transcatheter Aortic Valve Replacement: Validation of Left Ventricular Outflow Tract Diameter and Pulsed-Wave Doppler Location and Impact of Three-Dimensional Measurements - 03/11/15
Abstract |
Background |
Echocardiographic calculation of effective orifice area (EOA) after transcatheter aortic valve replacement is integral to the assessment of transcatheter heart valve (THV) function. The aim of this study was to determine the most accurate method for calculating the EOA of the Edwards SAPIEN and SAPIEN XT THVs.
Methods |
One hundred intraprocedural transesophageal echocardiograms were analyzed. To calculate the post–transcatheter aortic valve replacement left ventricular outflow tract (LVOT) stroke volume (SV), four diameters were measured using two-dimensional echocardiography: (1) baseline LVOT diameter (LVOTd_PRE), (2) postimplantation LVOT diameter, (3) native aortic annular diameter, and (4) THV in-stent diameter. Four corresponding areas were planimetered by three-dimensional echocardiography. Two LVOT velocity-time integrals (VTI) were measured with the pulsed-wave Doppler sample volume at (1) the proximal (apical) edge of the valve stent or (2) within the valve stent at the level of the THV cusps. LVOT velocity-time integral with the sample volume at the proximal edge of the valve stent was used with the LVOT and aortic annular measurements above, whereas in-stent VTI was paired with the in-stent THV diameter to yield eight different SVs. Right ventricular outflow tract (RVOT) SV was calculated using RVOT diameter and RVOT VTI and was used as the primary comparator. Transaortic VTI was obtained by continuous-wave Doppler, and EOA calculations using each SV measurement were compared with (1) EOA calculated using RVOTSV and (2) planimetered aortic valve area using three-dimensional echocardiography (AVAplanimetry3D).
Results |
Post–transcatheter aortic valve replacement EOA calculated using LVOTd_PRE was not significantly different from EOA calculated using RVOTSV (1.88 ± 0.33 vs 1.86 ± 0.39 cm2, P = .36) or from AVAplanimetry3D (1.85 ± 0.28, P = .38, n = 34). All other two-dimensional EOA calculations were statistically larger than EOA calculated using RVOTSV. All three-dimensional echocardiography–based EOA calculations were statistically different from AVAplanimetry3D.
Conclusions |
The most accurate EOA after implantation of a balloon-expandable THV is calculated using preimplantation LVOT diameter and VTI.
Le texte complet de cet article est disponible en PDF.Keywords : TAVR, Aortic stenosis, Echocardiography
Abbreviations : 2D, 2DE, 3D, 3DE, AnnDiam, AVAplanimetry3D, AV_VTI, DI_LVOT, DI_STENT, EOA, LVOTd, PRE, POST, RVOTd, StentDiam, TAVR, TEE, THV, VTI_LVOT, VTI_RVOT, VTI_STENT
Plan
| Dr Khalique is a consultant for Edwards Lifesciences and serves as a member of a cardiovascular core laboratory that holds contracts with Edwards Lifesciences, for which he receives no direct compensation. Dr Kodali has received consulting fees from Edwards Lifesciences. Dr Nazif has received consulting fees from Edwards Lifesciences and Medtronic. Dr Marcoff serves as a member of a cardiovascular core laboratory that has contracts with Edwards Lifesciences and Medtronic, for which he receives no direct compensation. Dr Williams is the principal investigator for the Evolut R clinical trial. Dr Leon is a nonpaid member of the Scientific Advisory Board of Edwards Lifesciences. Dr Hahn has core laboratory contracts with Edwards Lifesciences, for which she receives no direct compensation, and is a speaker for Philips Healthcare, St. Jude Medical, and Boston Scientific. All other authors have no disclosures. |
Vol 28 - N° 11
P. 1283-1293 - novembre 2015 Retour au numéro
Article précédent
- Differences in Natural History of Low- and High-Gradient Aortic Stenosis from Nonsevere to Severe Stage of the Disease
- Sebastian Herrmann, Bastian Fries, Dan Liu, Kai Hu, Stefan Stoerk, Wolfram Voelker, Catharina Ruppert, Kristina Lorenz, Georg Ertl, Frank Weidemann
- Increased Apical Rotation in Severe Aortic Stenosis is Associated with Reduced Survival: A Speckle-Tracking Study
- Anthony A. Holmes, Cynthia C. Taub, Mario J. Garcia, Jian Shan, David P. Slovut
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?