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Dong T, Wang TKM. Assessing Severity of Aortic Stenosis on CT-Have We Arrived? Circ Cardiovasc Imaging 2024; 17:e016920. [PMID: 38771903 DOI: 10.1161/circimaging.124.016920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Tiffany Dong
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, OH
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller Heart, Vascular, and Thoracic Institute, Cleveland, OH
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2
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Ash J, Sandhu GS, Arriola‐Montenegro J, Agakishiev D, Clavel M, Pibarot P, Duval S, Nijjar PS. Performance of Computed Tomographic Angiography-Based Aortic Valve Area for Assessment of Aortic Stenosis. J Am Heart Assoc 2023; 12:e029973. [PMID: 37581391 PMCID: PMC10492957 DOI: 10.1161/jaha.123.029973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023]
Abstract
Background A total of 40% of patients with severe aortic stenosis (AS) have low-gradient AS, raising uncertainty about AS severity. Aortic valve calcification, measured by computed tomography (CT), is guideline-endorsed to aid in such cases. The performance of different CT-derived aortic valve areas (AVAs) is less well studied. Methods and Results Consecutive adult patients with presumed moderate and severe AS based on echocardiography (AVA measured by continuity equation on echocardiography <1.5 cm2) who underwent cardiac CT were identified retrospectively. AVAs, measured by direct planimetry on CT (AVACT) and by a hybrid approach (AVA measured in a hybrid manner with echocardiography and CT [AVAHybrid]), were measured. Sex-specific aortic valve calcification thresholds (≥1200 Agatston units in women and ≥2000 Agatston units in men) were applied to adjudicate severe or nonsevere AS. A total of 215 patients (38.0% women; mean±SD age, 78±8 years) were included: normal flow, 59.5%; and low flow, 40.5%. Among the different thresholds for AVACT and AVAHybrid, diagnostic performance was the best for AVACT <1.2 cm2 (sensitivity, 85%; specificity, 26%; and accuracy, 72%), with no significant difference by flow status. The percentage of patients with correctly classified AS severity (correctly classified severe AS+correctly classified moderate AS) was as follows; AVA measured by continuity equation on echocardiography <1.0 cm2, 77%; AVACT <1.2 cm2, 73%; AVACT <1.0 cm2, 58%; AVAHybrid <1.2 cm2, 59%; and AVAHybrid <1.0 cm2, 45%. AVACT cut points of 1.52 cm2 for normal flow and 1.56 cm2 for low flow, provided 95% specificity for excluding severe AS. Conclusions CT-derived AVAs have poor discrimination for AS severity. Using an AVACT <1.2-cm2 threshold to define severe AS can produce significant error. Larger AVACT thresholds improve specificity.
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Affiliation(s)
- Jerry Ash
- Cardiovascular Division, Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Gurmandeep S. Sandhu
- Cardiovascular Division, Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | | | - Dzhalal Agakishiev
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Marie‐Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute)Laval UniversityQuebec CityCanada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute)Laval UniversityQuebec CityCanada
| | - Sue Duval
- Cardiovascular Division, Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Prabhjot S. Nijjar
- Cardiovascular Division, Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
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Canciello G, Pate S, Sannino A, Borrelli F, Todde G, Grayburn P, Losi MA, Esposito G. Pitfalls and Tips in the Assessment of Aortic Stenosis by Transthoracic Echocardiography. Diagnostics (Basel) 2023; 13:2414. [PMID: 37510158 PMCID: PMC10377988 DOI: 10.3390/diagnostics13142414] [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: 06/27/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Aortic stenosis (AS) is a valvular heart disease that significantly contributes to cardiovascular morbidity and mortality worldwide. The condition is characterized by calcification and thickening of the aortic valve leaflets, resulting in a narrowed orifice and increased pressure gradient across the valve. AS typically progresses from a subclinical phase known as aortic sclerosis, where valve calcification occurs without a transvalvular gradient, to a more advanced stage marked by a triad of symptoms: heart failure, syncope, and angina. Echocardiography plays a crucial role in the diagnosis and evaluation of AS, serving as the primary non-invasive imaging modality. However, to minimize misdiagnoses, it is crucial to adhere to a standardized protocol for acquiring echocardiographic images. This is because, despite continuous advances in echocardiographic technology, diagnostic errors still occur during the evaluation of AS, particularly in classifying its severity and hemodynamic characteristics. This review focuses on providing guidance for the imager during the echocardiographic assessment of AS. Firstly, the review will report on how the echo machine should be set to improve image quality and reduce noise and artifacts. Thereafter, the review will report specific emphasis on accurate measurements of left ventricular outflow tract diameter, aortic valve morphology and movement, as well as aortic and left ventricular outflow tract velocities. By considering these key factors, clinicians can ensure consistency and accuracy in the evaluation of AS using echocardiography.
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Affiliation(s)
- Grazia Canciello
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Shabnam Pate
- Division of Cardiology, Baylor Scott & White Research Institute, Plano, TX 75204, USA
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
- Division of Cardiology, Baylor Scott & White Research Institute, Plano, TX 75204, USA
| | - Felice Borrelli
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Gaetano Todde
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Paul Grayburn
- Division of Cardiology, Baylor Scott & White Research Institute, Plano, TX 75204, USA
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
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Bombace S, Meucci MC, Fortuni F, Ilardi F, Manzo R, Canciello G, Esposito G, Grayburn PA, Losi MA, Sannino A. Beyond Aortic Stenosis: Addressing the Challenges of Multivalvular Disease Assessment. Diagnostics (Basel) 2023; 13:2102. [PMID: 37370999 PMCID: PMC10297357 DOI: 10.3390/diagnostics13122102] [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: 05/17/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Aortic stenosis (AS) can often coexist with other valvular diseases or be combined with aortic regurgitation (AR), leading to unique pathophysiological conditions. The combination of affected valves can vary widely, resulting in a lack of standardized diagnostic or therapeutic approaches. Echocardiography is crucial in assessing patients with valvular heart disease (VHD), but careful consideration of the hemodynamic interactions between combined valvular defects is necessary. This is important as it may affect the reliability of commonly used echocardiographic parameters, making the diagnosis challenging. Therefore, a multimodality imaging approach, including computed tomography or cardiac magnetic resonance, is often not just beneficial but crucial. It represents the future of diagnostics in this intricate field due to its unprecedented capacity to quantify and comprehend valvular pathology. The absence of definitive data and guidelines for the therapeutic management of AS in the context of multiple valve lesions makes this condition particularly challenging. As a result, an individualized, case-by-case approach is necessary, guided primarily by the recommendations for the predominant valve lesion. This review aims to summarize the pathophysiology of AS in the context of multiple and mixed valve disease, with a focus on the hemodynamic implications, diagnostic challenges, and therapeutic options.
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Affiliation(s)
| | - Maria Chiara Meucci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | | | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
- Baylor Scott & White Research Institute, Plano, TX 75093, USA
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5
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Kim DH, Choi ES, Kwon BS, Yun TJ, Yang DH, Park CS. The Usefulness of Computed Tomography in Predicting Left Ventricular Outflow Tract Obstruction After Neonatal Arch Repair. Semin Thorac Cardiovasc Surg 2023; 35:127-137. [PMID: 35278666 DOI: 10.1053/j.semtcvs.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/11/2022]
Abstract
This study investigated the outcome after neonatal arch repair, and the usefulness of computed tomography (CT) in predicting the development of left ventricular outflow tract (LVOT) obstruction (LVOTO). A total of 150 neonates who underwent arch repair between 2008 and 2019 were included. The diameters of the aortic valve annulus (AVA) and LVOT in millimeters were measured with transthoracic echocardiography (TTE) or CT and indexed by subtracting body weight in kilograms. The outcomes of interest were the development of LVOTO (peak flow velocity > 3 m/s on TTE) and reintervention or reoperation for LVOTO. The median follow-up duration was 3.6 years. The rates of overall survival, freedom from reintervention for LVOTO, and freedom from the LVOTO development at 7 years were 93.7%, 88.2%, and 81.0%, respectively. In univariable Cox regression analysis, weight-indexed CT-measured LVOT diameter (concordance index [C-index] = 0.73, P = 0.002) and weight-indexed TTE-measured AVA diameter (C-index = 0.69, P = 0.001) were significant predictors of LVOTO. The maximal chi-square test identified the following cutoff values for predicting LVOTO: 1.4 for weight-indexed CT-measured LVOT diameter and 1.6 for weight-indexed TTE-measured AVA diameter. The high-risk group (both measures lower than the cutoff values) had a significantly lower rate of freedom from LVOTO development than the low-risk group (both measures higher than the cutoff values) (P < 0.001). The weight-indexed CT-measured LVOT diameter could be used to predict LVOTO development after neonatal arch repair, as an independent measure or complementary to traditional measures.
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Affiliation(s)
- Dong-Hee Kim
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Global Burden and Improvement Gap of Non-Rheumatic Calcific Aortic Valve Disease: 1990-2019 Findings from Global Burden of Disease Study 2019. J Clin Med 2022; 11:jcm11226733. [PMID: 36431213 PMCID: PMC9698619 DOI: 10.3390/jcm11226733] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/04/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to explore the most updated changing trends of non-rheumatic calcific aortic valve disease (nrCAVD) and reveal possible improvements. We analyzed the age-standardized rates (ASRs) of prevalence, incidence, disability-adjusted life-years (DALYs), and mortality trends of nrCAVD from 1990 to 2019 using data from the Global Burden of Disease (GBD) study 2019. The relations between ASRs and socio-demographic index (SDI) were analyzed with Pearson's correlation coefficients. Decomposition and frontier analysis were employed to reveal the contribution proportion of influence factors and regions where improvement can be achieved. In 2019, there were 9.40 million (95% uncertainty interval (UI): 8.07 to 10.89 million) individuals with nrCAVD globally. From 1990 to 2019, the prevalence rate of nrCAVD increased by 155.47% (95% IU: 141.66% to 171.7%), with the largest increase observed in the middle SDI region (821.11%, 95% UI: 709.87% to 944.23%). Globally, there were no significant changes in the mortality rate of nrCAVD (0.37%, 95% UI: -8.85% to 7.99%). The global DALYs decreased by 10.97% (95% UI: -17.94% to -3.46%). The population attributable fraction (PAF) of high systolic blood pressure increased in the population aged 15-49 years, while it declined slightly in population aged 50+ years. Population growth was the main contributing factor to the increased DALYs across the globe (74.73%), while aging was the driving force in the high-SDI region (80.27%). The Netherlands, Finland, Luxembourg, Germany, and Norway could reduce DALY rates of nrCAVD using their socio-demographic resources. According to these results, we revealed that the burden of nrCAVD increased markedly from 1990 to 2019 in high-SDI and high-middle-SDI regions. There was a downward trend in the mortality due to nrCAVD since 2013, which is possibly owing to profound advances in transcatheter aortic valve replacement. Some countries may reduce burdens of nrCAVD using their socio-demographic resources.
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Hoeijmakers MJMM, Morgenthaler V, Rutten MCM, van de Vosse FN. Scale-Resolving Simulations of Steady and Pulsatile Flow Through Healthy and Stenotic Heart Valves. J Biomech Eng 2022; 144:1119643. [PMID: 34529056 DOI: 10.1115/1.4052459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Indexed: 11/08/2022]
Abstract
Blood-flow downstream of stenotic and healthy aortic valves exhibits intermittent random fluctuations in the velocity field which are associated with turbulence. Such flows warrant the use of computationally demanding scale-resolving models. The aim of this work was to compute and quantify this turbulent flow in healthy and stenotic heart valves for steady and pulsatile flow conditions. Large eddy simulations (LESs) and Reynolds-averaged Navier-Stokes (RANS) simulations were used to compute the flow field at inlet Reynolds numbers of 2700 and 5400 for valves with an opening area of 70 mm2 and 175 mm2 and their projected orifice-plate type counterparts. Power spectra and turbulent kinetic energy were quantified on the centerline. Projected geometries exhibited an increased pressure-drop (>90%) and elevated turbulent kinetic energy levels (>147%). Turbulence production was an order of magnitude higher in stenotic heart valves compared to healthy valves. Pulsatile flow stabilizes flow in the acceleration phase, whereas onset of deceleration triggered (healthy valve) or amplified (stenotic valve) turbulence. Simplification of the aortic valve by projecting the orifice area should be avoided in computational fluid dynamics (CFD). RANS simulations may be used to predict the transvalvular pressure-drop, but scale-resolving models are recommended when detailed information of the flow field is required.
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Affiliation(s)
- M J M M Hoeijmakers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB The Netherlands; Ansys Inc., Villeurbanne 69100, France
| | | | - M C M Rutten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, The Netherlands
| | - F N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, The Netherlands
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8
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Choe YH, Kim SM, Park SJ. Computed tomography and magnetic resonance imaging assessment of aortic valve stenosis: an update. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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9
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Rong LQ, Hameed I, Di Franco A, Rahouma MM, Khan FM, Demetres M, Weinsaft JW, Devereux RB, Gaudino M. A pairwise meta-analytic comparison of aortic valve area determined by planimetric versus hemodynamic methods in aortic stenosis. Int J Cardiol 2020; 322:77-85. [PMID: 32916225 DOI: 10.1016/j.ijcard.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/07/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aortic valve area (AVA) is commonly determined from 2-dimensional transthoracic echocardiography (2D TTE) by the continuity equation; however, this method relies on geometric assumptions of the left ventricular outflow tract which may not hold true. This study compared mean differences and correlations for AVA by planimetric (2-dimensional transesophageal echocardiography [2D TEE], 3-dimensional transesophageal echocardiography [3D TEE], 3-dimensional transthoracic echocardiography [3D TTE], multi-detector computed tomography [MDCT], and magnetic resonance imaging [MRI]) with hemodynamic methods (2D TTE and catheterization) using pairwise meta-analysis. METHOD Ovid MEDLINE®, Ovid EMBASE, and The Cochrane Library (Wiley) were queried for studies comparing AVA measurements assessed by planimetric and hemodynamic techniques. Pairwise meta-analysis for mean differences (using random effect model) and for correlation coefficients (r) were performed. RESULTS Forty-five studies (3014 patients) were included. Mean differences between planimetric and hemodynamic techniques were 0.12 cm2 (95%CI 0.10-0.15) for AVA (pooled r = 0.84; 95%CI 0.76-0.90); 1.36cm2 (95%CI 1.03-1.69) for left ventricular outflow tract area; and 0.13 cm (95%CI 0.07-0.20) for annular diameter (pooled r = 0.76; 95% CI 0.64-0.94); 0.67 cm2 (95%CI 0.59-0.76) for annular area (pooled r = 0.74; 95%CI 0.55-0.86). CONCLUSIONS Planimetric techniques slightly, but significantly, overestimate AVA when compared to hemodynamic techniques.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA.
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Mohamed M Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Faiza M Khan
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Medicine/Cardiology Division, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Richard B Devereux
- Department of Medicine/Cardiology Division, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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Pawade T, Sheth T, Guzzetti E, Dweck MR, Clavel MA. Why and How to Measure Aortic Valve Calcification in Patients With Aortic Stenosis. JACC Cardiovasc Imaging 2020; 12:1835-1848. [PMID: 31488252 DOI: 10.1016/j.jcmg.2019.01.045] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 10/26/2022]
Abstract
The first-line evaluation of aortic stenosis severity is Doppler echocardiography. However, in up to 40% of patients, resting echocardiographic assessment of aortic stenosis severity is discordant, leading to clinical uncertainty. Interest has therefore grown in aortic valve calcium scoring by multidetector computed tomography (CT-AVC) as an alternative load independent assessment of aortic stenosis severity. This paper will briefly review the pathophysiology of aortic stenosis and the crucial role that calcification plays in driving progressive obstruction of the valve. Subsequently, it will describe published reports that have investigated CT-AVC, validating this parameter against histology, and establishing its diagnostic accuracy versus echocardiography as well as its powerful independent prognostic capability. Finally, this review seeks to provide a practical guide about how best to acquire and interpret CT-AVC with a close focus on potential pitfalls and how these might be best avoided as this technique becomes more widely adopted in to clinical practice.
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Affiliation(s)
- Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tej Sheth
- Division of Cardiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
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Antonini-Canterin F, Faganello G, Mantero A, Citro R, Colonna P, Giorgi M, Manuppelli V, Monte I, Petrella L, Posteraro A, Di Bello V, Carerj S, Benedetto F. Cardiovascular Multimodality Imaging: It is Time to Get on Board! A "Società Italiana di Ecocardiografia e CardioVascular Imaging" Statement. J Cardiovasc Echogr 2018; 28:1-8. [PMID: 29629253 PMCID: PMC5875130 DOI: 10.4103/jcecho.jcecho_66_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Francesco Antonini-Canterin
- Ospedale Riabilitativo di Alta Specializzazione, Unità Operativa di Cardiologia Riabilitativa e Preventiva, Motta di Livenza, Italy
| | - Giorgio Faganello
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Antonio Mantero
- Società Italiana di Ecocardiografia e CardioVascular Imaging, Milano, Italy
| | - Rodolfo Citro
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Paolo Colonna
- Department of Cardiology, Hospital Policlinico of Bari, Bari, Italy
| | - Mauro Giorgi
- Department of Torino Cardiovascular, San Giovanni Battista Hospital, Torino, Italy
| | | | - Ines Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Licia Petrella
- Department of Cardiac Surgery, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Alfredo Posteraro
- Medical Department, Cardiology Unit, Presidio Ospedaliero Integrato Portuense, Roma, Italy
| | | | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Frank Benedetto
- Unità Operativa Complessa, Clinical and Rehabilitation Cardiology, Reggio Calabria, Italy
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12
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Minami K, Yoneyama K, Izumo M, Suzuki K, Ogawa Y, Chikaraishi K, Ogawa Y, Kobayashi Y, Furukawa T, Tanabe Y, Akashi YJ. Influence of aortic valve leaflet calcification on dynamic aortic valve motion assessed by cardiac computed tomography. J Cardiovasc Comput Tomogr 2016; 10:485-490. [PMID: 27597530 DOI: 10.1016/j.jcct.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/09/2016] [Accepted: 08/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Computed tomography is the best noninvasive imaging modality for evaluating valve leaflet calcification. OBJECTIVE To evaluate the association of aortic valve leaflet calcification with instantaneous valve opening and closing using dynamic multidetector computed tomography (MDCT). METHODS We retrospectively evaluated 58 consecutive patients who underwent dynamic MDCT imaging. Aortic valve calcification (AVC) was quantified using the Agatston method. The aortic valve area (AVA) tracking curves were derived by planimetry during the cardiac cycle using all 20 phases (5% reconstruction). da/dt in cm2/s was calculated as the rate of change of AVA during opening (positive) or closing (negative). Patients were divided into 3 three groups according to Agatston score quartile: no AVC (Q2, Score 0, n = 18), mild AVC (Q3, Score 1-2254, n = 24), and severe AVC (Q4 Score >2254, n = 14). RESULTS In multivariable linear regression, compared to the non AVC group, the mild and severe AVC groups had lower maximum AVA (by -1.71 cm2 and -2.25 cm2, respectively), lower peak positive da/dt (by -21.88 cm2/s and -26.65 cm2/s, respectively), and higher peak negative da/dt (by 13.78 cm2/s and 18.11 cm2/s, respectively) (p < 0.05 for all comparisons). CONCLUSIONS AVA and its opening and closing were influenced by leaflet calcification. The present study demonstrates the ability of dynamic MDCT imaging to assess quantitative aortic valve motion in a clinical setting.
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Affiliation(s)
- Keisuke Minami
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuyoshi Ogawa
- Radiological Technology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kousuke Chikaraishi
- Radiological Technology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yukihisa Ogawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuyuki Kobayashi
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiyuki Furukawa
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
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Larsen LH, Kofoed KF, Carstensen HG, Dalsgaard M, Ersbøll MK, Køber L, Hassager C. Prognostic value of multi-detector computed tomography in asymptomatic aortic valve stenosis. Int J Cardiol 2016; 203:331-7. [DOI: 10.1016/j.ijcard.2015.10.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 09/28/2015] [Accepted: 10/12/2015] [Indexed: 11/26/2022]
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14
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Levine A, Hecht HS. Cardiac CT Angiography in Congestive Heart Failure. J Nucl Med 2015; 56 Suppl 4:46S-51S. [DOI: 10.2967/jnumed.114.150441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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16
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Burwash IG. Echocardiographic Evaluation of Aortic Stenosis - Normal Flow and Low Flow Scenarios. Eur Cardiol 2014; 9:92-99. [PMID: 30310493 PMCID: PMC6159432 DOI: 10.15420/ecr.2014.9.2.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/11/2014] [Indexed: 02/07/2023] Open
Abstract
The echocardiographic evaluation of the patient with aortic stenosis (AS) has evolved in recent years, beyond confirming the diagnosis and measuring the resting mean pressure gradient or valve area. New echocardiographic approaches have developed to address the clinical dilemmas related to discordant haemodynamic data, asymptomatic haemodynamically severe AS and low-flow, low-gradient AS in order to better evaluate the disease severity, enhance the risk stratification of patients and provide important prognostic information. This article reviews the echocardiographic evaluation of the AS patient and focuses on the echocardiographic assessment of the haemodynamic severity, the prediction of clinical outcome and the use of echocardiography to guide patient management in the presence of normal flow and low flow scenarios.
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Affiliation(s)
- Ian G Burwash
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
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Rajani R, Khattar R, Chiribiri A, Victor K, Chambers J. Multimodality imaging of heart valve disease. Arq Bras Cardiol 2014; 103:251-63. [PMID: 24830387 PMCID: PMC4193073 DOI: 10.5935/abc.20140057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/07/2014] [Indexed: 11/22/2022] Open
Abstract
Unidentified heart valve disease is associated with a significant morbidity and
mortality. It has therefore become important to accurately identify, assess and
monitor patients with this condition in order that appropriate and timely
intervention can occur. Although echocardiography has emerged as the predominant
imaging modality for this purpose, recent advances in cardiac magnetic resonance and
cardiac computed tomography indicate that they may have an important contribution to
make. The current review describes the assessment of regurgitant and stenotic heart
valves by multimodality imaging (echocardiography, cardiac computed tomography and
cardiac magnetic resonance) and discusses their relative strengths and
weaknesses.
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Affiliation(s)
- Ronak Rajani
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
| | - Rajdeep Khattar
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- Divisions of Imaging Sciences, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom
| | - Kelly Victor
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
| | - John Chambers
- Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
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18
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Feuchtner G. Imaging of cardiac valves by computed tomography. SCIENTIFICA 2013; 2013:270579. [PMID: 24490107 PMCID: PMC3893874 DOI: 10.1155/2013/270579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 11/12/2013] [Indexed: 06/03/2023]
Abstract
This paper describes "how to" examine cardiac valves with computed tomography, the normal, diseased valves, and prosthetic valves. A review of current scientific literature is provided. Firstly, technical basics, "how to" perform and optimize a multislice CT scan and "how to" interpret valves on CT images are outlined. Then, diagnostic imaging of the entire spectrum of specific valvular disease by CT, including prosthetic heart valves, is highlighted. The last part gives a guide "how to" use CT for planning of transcatheter aortic valve implantation (TAVI), an emerging effective treatment option for patients with severe aortic stenosis. A special focus is placed on clinical applications of cardiac CT in the context of valvular disease.
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Affiliation(s)
- Gudrun Feuchtner
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria
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19
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Rajani R, Brum RL, Barden E, Drake S, Preston RL, Carr-White G, Chambers JB. An insight into transcatheter aortic valve implantation-a perspective from multidetector-computed tomography. Catheter Cardiovasc Interv 2013; 82:E952-8. [PMID: 22926967 DOI: 10.1002/ccd.24624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 08/20/2012] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has now become an acceptable alternative to surgical aortic valve replacement for patients with severe aortic stenosis at high risk. The early enthusiasm for this technology has not diminished but rather has developed at an unprecedented rate over the last decade. Alongside the developments in implantation technique, transcatheter design, and postprocedural care, cardiac imaging modalities have also had to concurrently evolve to meet the perpetual demand for lower peri- and postprocedural complication rates. Although transthoracic and transesophageal echocardiography remain vital in patient's selection and periprocedural guidance, there is now emerging evidence that indicates that multidetector-computed tomography (MDCT) may also have an equally important role to play. The aim of the current review is to examine the modern role of MDCT in assessing patients with aortic stenosis being considered for TAVI.
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Affiliation(s)
- Ronak Rajani
- Department of Cardiac Computed Tomography, St Thomas' Hospital, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' Hospital, London, United Kingdom
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20
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Dill KE, George E, Abbara S, Cummings K, Francois CJ, Gerhard-Herman MD, Gornik HL, Hanley M, Kalva SP, Kirsch J, Kramer CM, Majdalany BS, Moriarty JM, Oliva IB, Schenker MP, Strax R, Rybicki FJ. ACR appropriateness criteria imaging for transcatheter aortic valve replacement. J Am Coll Radiol 2013; 10:957-65. [PMID: 24183748 DOI: 10.1016/j.jacr.2013.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/08/2013] [Indexed: 02/06/2023]
Abstract
Although aortic valve replacement is the definitive therapy for severe aortic stenosis, almost half of patients with severe aortic stenosis are unable to undergo conventional aortic valve replacement because of advanced age, comorbidities, or prohibitive surgical risk. Treatment options have been recently expanded with the introduction of catheter-based implantation of a bioprosthetic aortic valve, referred to as transcatheter aortic valve replacement. Because this procedure is characterized by lack of exposure of the operative field, image guidance plays a critical role in preprocedural planning. This guideline document evaluates several preintervention imaging examinations that focus on both imaging at the aortic valve plane and planning in the supravalvular aorta and iliofemoral system. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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21
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Larsen LH, Kofoed KF, Carstensen HG, Mejdahl MR, Andersen MJ, Kjaergaard J, Nielsen OW, Køber L, Møgelvang R, Hassager C. Aortic valve area assessed with 320-detector computed tomography: comparison with transthoracic echocardiography. Int J Cardiovasc Imaging 2013; 30:165-73. [DOI: 10.1007/s10554-013-0295-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/15/2013] [Indexed: 12/01/2022]
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22
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Lee AM, Beaudoin J, Thai WE, Wai B, Hui GC, Sidhu MS, Engel LC, Abbara S, Hoffmann U, Ghoshhajra BB. Feasibility of aortic valve assessment with low dose prospectively triggered adaptive systolic (PTAS) cardiac computed tomography angiography. BMC Res Notes 2013; 6:158. [PMID: 23602055 PMCID: PMC3640955 DOI: 10.1186/1756-0500-6-158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac computed tomography angiography (CTA) is feasible for aortic valve evaluation, but retrospective gated protocols required high radiation doses for aortic valve assessment. A prospectively triggered adaptive systolic (PTAS) cardiac CT protocol was recently described in arrhythmia using second-generation dual-source CT. In this study, we sought to evaluate the feasibility of PTAS CTA to assess the aortic valve at a low radiation dose. FINDINGS A retrospective cohort of 29 consecutive patients whom underwent PTAS protocols for clinical indications other than aortic valve assessment and whom also received echocardiography within 2 months of CT, was identified. Images were reviewed for aortic valve morphology (tricuspid/bicuspid/prosthetic) and stenosis (AS) by experienced blinded readers. Accuracy versus echocardiography and radiation doses were assessed. CONCLUSIONS PTAS CTA protocols using second-generation dual-source CT for aortic valve evaluation are feasible at low doses. This protocol should be investigated further in larger cohorts.
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23
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Cuéllar H, Roque A, Pineda V, Rodríguez J. Cardiac computed tomography for valve disease. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2012.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Kherada N, Mehran R. Pursuit of perfection: three-dimensional CT angiographic "objective quantification" of aortic valve structures for transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2013; 81:160-1. [PMID: 23281090 DOI: 10.1002/ccd.24759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 11/16/2012] [Indexed: 11/06/2022]
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25
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Buttan AK, Yang EH, Budoff MJ, Vorobiof G. Evaluation of valvular disease by cardiac computed tomography assessment. J Cardiovasc Comput Tomogr 2012; 6:381-92. [DOI: 10.1016/j.jcct.2012.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 12/31/2022]
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26
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Multidetector row computed tomography assessment of the native aortic and mitral valve: a call for routine assessment of left-sided heart valves during coronary computed tomography. Cardiol Rev 2012; 20:222-9. [PMID: 23045729 DOI: 10.1097/crd.0b013e318250eaaa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aortic valve stenosis and mitral valve regurgitation are the most common valvular heart diseases (VHD) in Western countries. In daily clinical practice, the diagnosis and evaluation of the severity of VHD is based on clinical findings and imaging. Transthoracic echocardiography is the preferred imaging technique for the initial evaluation of VHD. In patients with inconclusive transthoracic echocardiography, transoesophageal echocardiography can have additional diagnostic value. Cardiac multidetector row computed tomography (MDCT) has proven to have diagnostic value in the evaluation of coronary artery disease in symptomatic patients with a low-to-intermediate pretest probability. The images acquired for coronary assessment also contain diagnostic information on heart valves. The purpose of this review was to discuss the diagnostic value of MDCT for the evaluation of left-sided VHD. We provide an overview of the literature comparing echocardiography and MDCT for VHD assessment focusing on aortic valve and mitral valve disease, and we present clinical recommendations.
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27
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Cardiac computed tomography for valve disease. RADIOLOGIA 2012; 55:24-36. [PMID: 22947120 DOI: 10.1016/j.rx.2012.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 11/20/2022]
Abstract
Heart valve disease and coronary heart disease are very prevalent in the general population and often coincide in the same patient. Cardiac computed tomography (CT) makes it possible to noninvasively rule out coronary disease before valve surgery and to potentially avoid invasive heart catheterization in 66% to 75% of patients. The same imaging test provides abundant anatomic and functional information that complements the information from echocardiography, making it possible to characterize the etiology of the valve disease and its repercussions on the heart and aorta, as well as to quantify the severity of disease affecting the valves of the left side of the heart. In this article, we describe the anatomy of the heart valves and the technical requisites of cardiac CT for the study of the valves. We go on to explore the usefulness of CT in the preoperative study of the coronary arteries and in the morphological and functional characterization of valve disease, with special emphasis on the valves of the left side of the heart.
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28
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Pires de Morais G, Bettencourt N, Silva G, Ferreira N, Sousa O, Caeiro D, Rocha J, Carvalho M, Leite D, Braga P, Fonseca C, Gama V. [Multislice computed tomography in the selection of candidates for transcatheter aortic valve implantation]. Rev Port Cardiol 2011; 30:717-26. [PMID: 21958996 DOI: 10.1016/s0870-2551(11)70015-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/24/2011] [Indexed: 10/16/2022] Open
Abstract
Transcatheter aortic valve implantation is an emerging treatment option for severe symptomatic aortic stenosis in patients considered unsuitable for surgical valve replacement. The authors review the use of multislice computed tomography in the selection of candidates for transcatheter aortic valve replacement, procedural support and post-interventional follow-up. A single-center experience of the role of this imaging technique is also described. Multislice computed tomography is an essential imaging tool in the selection and exclusion of candidates for transcatheter aortic valve implantation, providing evaluation of coronary anatomy and the relationship of the coronary ostia with the aortic valve structure, and accurate analysis of the valve annulus and aortic root, left ventricular outflow tract, aorta and peripheral vascular access routes. Multislice computed tomography is also central to the choice of appropriate prosthesis size. In addition, it guides arterial puncture by image fusion techniques and enables correct prosthesis apposition to be verified. This review aims to describe the role of computed tomography in this increasingly common interventional valve procedure, providing an overview of current knowledge and applications.
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Affiliation(s)
- Gustavo Pires de Morais
- Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
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29
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Quantification of aortic valve area at 256-slice computed tomography: Comparison with transesophageal echocardiography and cardiac catheterization in subjects with high-grade aortic valve stenosis prior to percutaneous valve replacement. Eur J Radiol 2011; 80:151-7. [DOI: 10.1016/j.ejrad.2010.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 07/19/2010] [Accepted: 07/20/2010] [Indexed: 11/21/2022]
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30
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Multislice computed tomography in the selection of candidates for transcatheter aortic valve implantation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2174-2049(11)70015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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31
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Mizia-Stec K, Pysz P, Jasiński M, Adamczyk T, Drzewiecka-Gerber A, Chmiel A, Krejca M, Bochenek A, Woś S, Sosnowski M, Gąsior Z, Trusz-Gluza M, Tendera M. Preoperative quantification of aortic valve stenosis: comparison of 64-slice computed tomography with transesophageal and transthoracic echocardiography and size of implanted prosthesis. Int J Cardiovasc Imaging 2011; 28:343-52. [PMID: 21279693 PMCID: PMC3288372 DOI: 10.1007/s10554-010-9784-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 12/23/2010] [Indexed: 11/30/2022]
Abstract
Precise measurements of aortic complex diameters are essential for preoperative examinations of patients with aortic stenosis (AS) scheduled for aortic valve (AV) replacement. We aimed to prospectively compare the accuracy of transthoracic echocardiography (TTE), transoesophageal echocardiography (TEE) and multi-slice computed tomography (MSCT) measurements of the AV complex and to analyze the role of the multi-modality aortic annulus diameter (AAd) assessment in the selection of the optimal prosthesis to be implanted in patients surgically treated for degenerative AS. 20 patients (F/M: 3/17; age: 69 ± 6.5 years) with severe degenerative AS were enrolled into the study. TTE, TEE and MSCT including AV calcium score (AVCS) assessment were performed in all patients. The values of AAd obtained in the long AV complex axis (TTE, TEE, MSCT) and in multiplanar perpendicular imaging (MSCT) were compared to the size of implanted prosthesis. The mean AAd was 24 ± 3.6 mm using TTE, 26 ± 4.2 mm using TEE, and 26.9 ± 3.2 in MSCT (P = 0.04 vs. TTE). The mean diameter of the left ventricle out-flow tract in TTE (19.9 ± 2.7 mm) and TEE (19.5 ± 2.7 mm) were smaller than in MSCT (24.9 ± 3.3 mm, P < 0.001 for both). The mean size of implanted prosthesis (22.2 ± 2.3 mm) was significantly smaller than the mean AAd measured by TTE (P = 0.0039), TEE (P = 0.0004), and MSCT (P < 0.0001). The implanted prosthesis size correlated significantly to the AAd: r = 0.603, P = 0.005 for TTE, r = 0.592, P = 0.006 for TEE, and r = 0.791, P < 0.001 for MSCT. Obesity and extensive valve calcification (AV calcium score ≥ 3177Ag.U.) were identified as potent factors that caused a deterioration of both TTE and MSCT performance. The accuracy of AAd measurements in TEE was only limited by AV calcification. In multivariate regression analysis the mean value of the minimum and maximum AAd obtained in MSCT-multiplanar perpendicular imaging was an independent factor (r = 0.802, P < 0.0001) predicting the size of implanted prosthesis. In patients with AS echocardiography remains the main diagnostics tool in clinical practice. MSCT as a 3-dimentional modality allows for accurate measurement of entire AV complex and facilitates optimal matching of prosthesis size.
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Affiliation(s)
- Katarzyna Mizia-Stec
- Department of Cardiology, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland.
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Pflederer T, Achenbach S. Aortic valve stenosis: CT contributions to diagnosis and therapy. J Cardiovasc Comput Tomogr 2010; 4:355-64. [DOI: 10.1016/j.jcct.2010.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 09/26/2010] [Accepted: 09/30/2010] [Indexed: 10/19/2022]
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33
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Feuchtner GM. The utility of computed tomography in the context of aortic valve disease. Int J Cardiovasc Imaging 2009; 25:611-4. [PMID: 19468861 DOI: 10.1007/s10554-009-9472-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 05/20/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Gudrun M Feuchtner
- Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria.
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