Integration of 3D Imaging Data in the Assessment of Aortic Stenosis

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Abstract
Background—: In patients with aortic stenosis (AS), precise assessment of severity is critical for treatment decisions. Estimation of aortic valve area (AVA) with transthoracic echocardiographic (TTE)-continuity equation (CE) assumes a circular left ventricular outflow tract (LVOT). We evaluated incremental utility of 3D multidetector computed tomography (MDCT) over TTE assessment of AS severity. Methods and Results—: We included 51 patients (age, 81±8 years; 61% men; mean gradient, 42±12 mm Hg) with calcific AS who underwent evaluation for treatment options. TTE parameters included systolic LVOT diameter (D) and continuous and pulsed wave (CW and PW) velocity-time integrals (VTI) through the LVOT and mean transaortic gradient. MDCT parameters included systolic LVOT area, ratio of maximal to minimal LVOT diameter (eccentricity index), and aortic planimetry (AVA p ). TTE-CE AVA [(D 2 ×0.786×VTIpw)/VTIcw] and dimensionless index (DI) [VTIpw/VTIcw] were calculated. Corrected AVA was calculated by substituting MDCT LVOT area into CE. The majority (96%) of patients had eccentric LVOT. LVOT area, measured on MDCT, was higher than on TTE (3.84±0.8 cm 2 versus 3.03±0.5 cm 2 , P p and corrected AVA (0.67±0.1cm 2 , 0.82±0.3 cm 2 , and 0.86±0.3 cm 2 , P 2 ), which increased to 92% using corrected CE. Conclusions—: In patients with suspected severe AS, incorporation of MDCT-LVOT area into CE improves congruence for AS severity.

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