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Laohachewin D, Ruile P, Breitbart P, Minners J, Jander N, Soschynski M, Schlett CL, Neumann FJ, Westermann D, Hein M. Quantification of Aortic Valve Calcification in Contrast-Enhanced Computed Tomography. J Clin Med 2024; 13:2386. [PMID: 38673658 PMCID: PMC11051576 DOI: 10.3390/jcm13082386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The goal of our study is to evaluate a method to quantify aortic valve calcification (AVC) in contrast-enhanced computed tomography for patients with suspected severe aortic stenosis pre-interventionally. Methods: A total of sixty-five patients with aortic stenosis underwent both a native and a contrast-enhanced computed tomography (CECT) scan of the aortic valve (45 in the training cohort and 20 in the validation cohort) using a standardized protocol. Aortic valve calcification was semi-automatically quantified via the Agatston score method for the native scans and was used as a reference. For contrast-enhanced computed tomography, a calcium threshold of the Hounsfield units of the aorta plus four times the standard deviation was used. Results: For the quantification of aortic valve calcification in contrast-enhanced computed tomography, a conversion formula (691 + 1.83 x AVCCECT) was derived via a linear regression model in the training cohort. The validation in the second cohort showed high agreement for this conversion formula with no significant proportional bias (Bland-Altman, p = 0.055) and with an intraclass correlation coefficient in the validation cohort of 0.915 (confidence interval 95% 0.786-0.966) p < 0.001. Conclusions: Calcium scoring in patients with aortic valve stenosis can be performed using contrast-enhanced computed tomography with high validity. Using a conversion factor led to an excellent agreement, thereby obviating an additional native computed tomography scan. This might contribute to a decrease in radiation exposure.
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Affiliation(s)
- Danai Laohachewin
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Jan Minners
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Nikolaus Jander
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
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Flores-Umanzor E, Keshvara R, Reza S, Asghar A, Rashidul Anwar M, Cepas-Guillen PL, Osten M, Halankar J, Abrahamyan L, Horlick E. A systematic review of contrast-enhanced computed tomography calcium scoring methodologies and impact of aortic valve calcium burden on TAVI clinical outcomes. J Cardiovasc Comput Tomogr 2023; 17:373-383. [PMID: 37635033 DOI: 10.1016/j.jcct.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
Different methodologies have been used to assess the role of AV calcification (AVC) on TAVI outcomes. This systematic review aims to describe the burden of AVC, synthesize the different methods of calcium score quantification, and evaluate the impact of AVC on outcomes after TAVI. We included studies of TAVI patients who had reported AV calcium scoring by contrast-enhanced multidetector CT and the Agatston method. The impact of calcification on TAVI outcomes without restrictions on follow-up time or outcome type was evaluated. Results were reported descriptively, and a meta-analysis was conducted when feasible. Sixty-eight articles were included, with sample sizes ranging from 23 to 1425 patients. Contrast-enhanced calcium scoring was reported in 30 studies, calcium volume score in 28 studies, and unique scoring methods in two. All studies with calcium volume scores had variable protocols, but most utilized a modified Agatston method with variable attenuation threshold values of 300-850 HU. Eight studies used the Agatston method, with the overall mean AV calcium score in studies published from 2010 to 2012 of 3342.9 AU [95%CI: 3150.4; 3535.4, I2 = 0%]. The overall mean score was lower and heterogenous in studies published from 2014 to 2020 (2658.9 AU [95% CI: 2517.3; 2800.5, I2 = 79%]. Most studies reported a positive association between calcium burden and increased risk of adverse outcomes, including implantation of permanent pacemaker (7/8 studies), paravalvular leak (13/13 studies), and risk of aortic rupture (2/2 studies). AVC quantification methodology with contrast-enhanced CT is still variable. AVC negatively impacts TAVI outcomes independently of the quantification method.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajesh Keshvara
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Seleman Reza
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Areeba Asghar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Mohammed Rashidul Anwar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Spain
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jaydeep Halankar
- Joint Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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Stachel G, Abdel-Wahab M, de Waha-Thiele S, Desch S, Feistritzer HJ, Kitamura M, Farhan S, Eitel I, Kurz T, Thiele H. Fractal dimension of the aortic annulus: a novel predictor of paravalvular leak after transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2022; 38:2469-2478. [PMID: 36434335 PMCID: PMC9700572 DOI: 10.1007/s10554-022-02657-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/22/2022] [Indexed: 12/14/2022]
Abstract
To evaluate the prognostic relevance of aortic annulus (AA) and left ventricular outflow tract (LVOT) Fractal dimension (FD). FD is a mathematical concept that describes geometric complexity of a structure and has been shown to predict adverse outcomes in several contexts. Computed tomography (CT) scans from the SOLVE-TAVI trial, which, in a 2 × 2 factorial design, randomized 447 patients to TAVI with the balloon-expandable Edwards Sapien 3 or the self-expanding Medtronic Evolut R, and conscious sedation or general anesthesia, were analyzed semi-automatically with a custom-built software to determine border of AA and LVOT. FD was measured by box counting using grid calibers between 0.8 and 6.75 mm and was compared between patients with none/trivial and mild/moderate paravalvular regurgitation (PVR). Overall, 122 patients had CT scans sufficient for semi-automatic PVR in 30-day echocardiography. PVR was none in 65(53.3%) patients, trace in 9(7.4%), mild in 46(37.7%), moderate in 2(1.6%) and severe in 0 patients. FD determined in diastolic images was significantly higher in patients with mild/moderate PVR (1.0558 ± 0.0289 vs. 1.0401 ± 0.0284, p = 0.017). Annulus eccentricity was the only conventional measure of AA and LVOT geometry significantly correlated to FD (R = 0.337, p < 0.01). Area under the curve (AUC) of diastolic annular FD for prediction of mild/moderate PVR in ROC analysis was 0.661 (0.542-0.779, p = 0.014). FD shows promise in prediction of PVR after TAVI. Further evaluation using larger patient numbers and refined algorithms to better understand its predictive performance is warranted.Trial Registration: www.clinicaltrials.gov , identifier: NCT02737150, date of registration: 13.04.2016.
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Affiliation(s)
- Georg Stachel
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Suzanne de Waha-Thiele
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany ,University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ingo Eitel
- University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany ,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Luebeck/Kiel, Lübeck, Germany
| | - Thomas Kurz
- University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Parikh PB, Romeiser JL, Dhautel B, Mitchell D, Holecek W, Bilfinger T, Poppers J, Bennett-Guerrero E. Predictors and impact of low diastolic blood pressure and widened pulse pressure following transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:20-25. [PMID: 34764032 DOI: 10.1016/j.carrev.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR. METHODS The study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality. RESULTS Post-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97-6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07-7.07), p = 0.04]. CONCLUSIONS In this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America.
| | - Jamie L Romeiser
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Britney Dhautel
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Duran Mitchell
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - William Holecek
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Jeremy Poppers
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Elliott Bennett-Guerrero
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
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Angelillis M, Costa G, De Backer O, Mochi V, Christou A, Giannini C, Spontoni P, De Carlo M, Søndergaard L, Miccoli M, Petronio AS. Threshold for calcium volume evaluation in patients with aortic valve stenosis: correlation with Agatston score. J Cardiovasc Med (Hagerstown) 2021; 22:496-502. [PMID: 33278208 DOI: 10.2459/jcm.0000000000001145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The evaluation of aortic valve calcium burden is important when planning for transcatheter aortic valve implantation (TAVI). Although a robust golden standard methodology is available for calcium evaluation on noncontrast-enhanced (NCE) computed tomographic (CT) series, a standard reference for calcium assessment on contrast-enhanced CT series is currently lacking. METHODS Two hundred and forty-four preprocedural CT scans from patients who had received TAVI were analysed. We correlated the aortic calcium volumes obtained on CE series at three thresholds [450, 850, and 'probe + 100' Hounsfield Units (HU)] with the Agatston score obtained on NCE scans. A subgroup analysis was performed taking into account the contrast enhancement of the left ventricular outflow tract (LVOT), with a prespecified cut-off of 300 HU. RESULTS The overall population analysis showed higher correlation with the Agatston score using the 850 HU threshold (r = 0.45, P < 0.0001); no correlation was found with the 450 HU threshold, whilst the 'probe + 100' HU threshold showed a weaker correlation (r = 0.30, P < 0.0001). In patients with LVOT enhancement less than 300 HU, 450 HU showed the highest accuracy in calcium identification (r = 0.70, P < 0.0001), whereas in patients with LVOT enhancement of at least 300 HU, the most accurate threshold was 850 HU (r = 0.46, P < 0.0001). CONCLUSION The thresholds for correct calcium identification using the automatic 3Mensio software depend on the contrast enhancement of aortic and cardiac structures, which can be estimated by measuring the HU in the LVOT. In patients with LVOT HU of less than 300, the correct threshold to be set in the software is 450 HU, whereas in patients with LVOT HU of at least 300 the correct threshold is 850 HU.
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Affiliation(s)
- Marco Angelillis
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Giulia Costa
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Veronica Mochi
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Andrea Christou
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Cristina Giannini
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Paolo Spontoni
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Marco De Carlo
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Anna S Petronio
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
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6
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Meguro K, Kumamaru H, Kohsaka S, Hashimoto T, Kakizaki R, Kitamura T, Shimizu H, Ako J. Transcatheter Aortic Valve Replacement in Patients With a Small Annulus - From the Japanese Nationwide Registry (J-TVT). Circ J 2021; 85:967-976. [PMID: 33642425 DOI: 10.1253/circj.cj-20-1084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The details and consequences of a small aortic annulus among transcatheter aortic valve replacement (TAVR) patients remain uncertain. This study investigated the short-term outcomes in patients with small annular size and compared the 30-day outcome between intra- and supra-annular devices, with similar outer casing diameter in this subgroup.Methods and Results:Cases registered in the Japanese national TAVR registry between August 2013 and December 2017 were analyzed. Among a total of 5,870 registered patients, 647 (11.0%) had small annulus (area ≤314 mm2) measured by multi-detector computed tomography. Patients with a small annulus had a significantly smaller indexed effective orifice area (iEOA, 1.10 cm2/m2[0.92-1.35] vs. 1.16 cm2/m2[0.96-1.39], P<0.001) and higher mean pressure gradient (mPG, 10.0 mmHg [6.9-14.2] vs. 8.5 mmHg [6.0-11.5], P<0.001) compared with a normal-sized annulus. Among patients with a small annulus, those receiving a 20 mm intra-annular device had a smaller iEOA (0.94 cm2/m2[0.78-1.06] vs. 1.07 cm2/m2[0.8-1.24], P=0.001) and higher mPG (14.0 mmHg [10.0-18.5] vs. 11.0 [7.0-14.0], P<0.001) compared with those receiving a 23-mm supra-annular device, although the incidence of paravalvular leakage (≥moderate) was similar (14.4% vs. 16.5%, P=0.69). CONCLUSIONS Patients with a small annulus were associated with less hemodynamic improvement. A supra-annular device is associated with better echocardiographic improvement in patients with a small annulus, without increasing paravalvular leakage.
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Affiliation(s)
- Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, the University of Tokyo
| | | | | | - Ryota Kakizaki
- Department of Cardiovascular Medicine, Kitasato University
| | | | | | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University
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Transcatheter aortic valve replacement with the balloon-expandable SAPIEN 3 valve: Impact of calcium score on valve performance and clinical outcomes. Int J Cardiol 2020; 306:20-24. [DOI: 10.1016/j.ijcard.2020.02.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
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Bax JJ, Delgado V, Hahn RT, Leipsic J, Min JK, Grayburn P, Sondergaard L, Yoon SH, Windecker S. Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2020; 13:124-139. [DOI: 10.1016/j.jcmg.2018.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/14/2023]
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Butter C, Kaneko H, Tambor G, Hara M, Neuss M, Hoelschermann F. Clinical utility of intraprocedural three-dimensional integrated image guided transcatheter aortic valve implantation using novel automated computed tomography software: A single-center preliminary experience. Catheter Cardiovasc Interv 2019; 93:722-728. [PMID: 30408327 DOI: 10.1002/ccd.27920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 05/14/2018] [Accepted: 09/09/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Novel automated computed tomography (CT) software (Valve ASSIST 2) has been developed for transcatheter aortic valve implantation (TAVI), which not only provides three-dimensional (3D) reconstruction of multidetector (MD) CT images, but also enables intraprocedural real-time fusion of fluoroscopic and MDCT images. We aimed to clarify the reproducibility and accuracy of this software in the aortic annulus assessment and verify the potential of intraprocedural integrated MDCT imaging for TAVI. METHODS AND RESULTS We examined 50 patients with severe aortic stenosis undergoing transfemoral TAVI. Aortic annulus measurements were performed using 3mensio and the novel planning software. For intraprocedural imaging, preoperative CT dataset was overlaid onto fluoroscopy with the fusion software. The two images were aligned using the aortic root anatomy visible on both modalities. Novel planning software provided excellent reproducibility for the measurement of aortic annulus area (intraobserver intraclass correlation coefficients [ICC] 0.959, interobserver ICC 0.941), and perimeter (intraobserver ICC 0.915, interobserver ICC 0.912). Excellent correlation was found between novel planning software and 3mensio (ICC 0.952 for aortic annulus area, and 0.923 for perimeter). Intraprocedural fusion image of CT aortography and fluoroscopic aortic root aortography generated by this novel software identified coronary orifices and the distribution of aortic valve calcification during the device positioning. Fusion image displayed coronary orifices after device implantation. CONCLUSIONS Novel planning software showed excellent reproducibility and accuracy in the assessment of aortic root anatomy. Furthermore, the integrated 3D fusion image might have a potential as an intraprocedural imaging modality to contribute to the development of a safer TAVI procedure.
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Affiliation(s)
- Christian Butter
- Herzzentrum Brandenburg in Bernau bei Berlin & Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Hidehiro Kaneko
- Herzzentrum Brandenburg in Bernau bei Berlin & Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Grit Tambor
- Herzzentrum Brandenburg in Bernau bei Berlin & Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Masahiko Hara
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Michael Neuss
- Herzzentrum Brandenburg in Bernau bei Berlin & Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Frank Hoelschermann
- Herzzentrum Brandenburg in Bernau bei Berlin & Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
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Kim WK, Möllmann H, Liebetrau C, Renker M, Rolf A, Simon P, Van Linden A, Arsalan M, Doss M, Hamm CW, Walther T. The ACURATE neo Transcatheter Heart Valve. JACC Cardiovasc Interv 2018; 11:1721-1729. [DOI: 10.1016/j.jcin.2018.04.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 01/29/2023]
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11
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Akodad M, Lattuca B, Agullo A, Macia JC, Gandet T, Marin G, Iemmi A, Vernhet H, Schmutz L, Nagot N, Albat B, Cayla G, Leclercq F. Prognostic Impact of Calcium Score after Transcatheter Aortic Valve Implantation Performed With New Generation Prosthesis. Am J Cardiol 2018; 121:1225-1230. [PMID: 29706182 DOI: 10.1016/j.amjcard.2018.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/12/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
Calcium score (CS) is a well-known prognostic factor after transcatheter aortic valve implantation (TAVI) performed with first generation prosthesis but few data are available concerning new generation valves. The aim of this study was to evaluate if CS remains a prognostic factor after Sapien 3 and Evolut R valves implantation. Agatston CS was evaluated on multislice computed tomography before TAVI in 346 patients implanted with Sapien XT (n = 61), CoreValve (n = 57) devices, (group 1, n = 118), and with new generation Sapien 3 (n = 147), Evolut R (n = 81) prosthesis, (group 2, n = 228). Major adverse cardiovascular events and aortic regurgitation (AR) were evaluated at 1 month. The 2 groups were similar at baseline except for logistic Euroscore (20.1% in group 1 vs 15.0 % in group 2; p = 0.001), chronic renal failure (44.1% vs 37.2% respectively, p = 0.007) and preprocedural CS (4,092 ± 2,176 vs 3,682 ± 2,109 respectively, p = 0.022). In group 1, 28 patients (23.7%) had adverse clinical events vs 21 (9.2%) in group 2 (p <0.01). In multivariate analysis, a higher CS was predictive of adverse events in group 1 (5,785 ± 3,285 vs 3,565 ± 1,331 p <0.0001) but not in group 2 (p = 0.28). A higher CS was associated with AR in group 1 (6,234 ± 2711 vs 3,429 ± 1,505; p <0.001) and in patients implanted with an Evolut R device from group 2 (4,085 ± 3,645 vs 2,551 ± 1,356; p = 0.01). In conclusion, CS appears as an important prognostic factor of major events after TAVI with first generation valves but not with new generation devices. CS remains associated with AR only with new generation self-expandable Evolut R devices.
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12
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Ando T, Takagi H, Telila T, Afonso L. Comparison of outcomes in new-generation versus early-generation heart valve in transcatheter aortic valve implantation: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:186-191. [DOI: 10.1016/j.carrev.2017.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 02/08/2023]
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Kaneko H, Hoelschermann F, Tambor G, Yoon SH, Neuss M, Butter C. Predictors of Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation for Aortic Stenosis Using New-Generation Balloon-Expandable SAPIEN 3. Am J Cardiol 2017; 119:618-622. [PMID: 28010874 DOI: 10.1016/j.amjcard.2016.10.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 11/25/2022]
Abstract
Paravalvular regurgitation (PVR) is a common and serious complication after transcatheter aortic valve implantation (TAVI). New-generation balloon-expandable SAPIEN 3 has an outer sealing skirt to minimize PVR. However, the predictors of PVR after SAPIEN 3 transcatheter heart valve (THV) implantation have not been well investigated. We sought to clarify the determinants of PVR after TAVI using SAPIEN 3 with quantitative multidetector computed tomography (MDCT) assessment. This study analyzed 281 patients with severe symptomatic aortic stenosis who underwent TAVI using SAPIEN 3. Quantitative assessment of aortic root dimensions and calcium volume for leaflet, annulus, and left ventricular outflow tract were retrospectively performed with MDCT. MDCT nominal area oversizing was calculated using the following formula: % oversizing = (THV nominal area/MDCT derived annular area - 1) × 100. Logistic regression analysis was performed to determine the predictors of PVR greater than or equal to mild. PVR greater than or equal to mild was observed in 19% (53 of 281). Quantity and asymmetry of aortic valve calcium of annulus, left ventricular outflow tract, and leaflet were associated with higher incidence of PVR greater than or equal to mild, except leaflet asymmetry. Lower percentage of THV oversizing was also associated with PVR. Multivariable logistic regression analysis showed that larger calcification volume of annulus and lower percentage of THV oversizing were independent predictors of PVR greater than or equal to mild. These results suggest that prosthesis/annulus incongruence and aortic annulus calcification predicted PVR greater than or equal to mild after TAVI using SAPIEN 3.
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