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Holy EW, Nguyen-Kim TDL, Hoffelner L, Stocker D, Stadler T, Stähli BE, Kebernik J, Maisano F, Kasel MA, Frauenfelder T, Ruschitzka F, Nietlispach F, Tanner FC. Multimodality imaging derived energy loss index and outcome after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2020; 21:1092-1102. [DOI: 10.1093/ehjci/jeaa100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 01/06/2023] Open
Abstract
Abstract
Aims
To assess whether the combination of transthoracic echocardiography (TTE) and multidetector computed tomography (MDCT) data affects the grading of aortic stenosis (AS) severity under consideration of the energy loss index (ELI) in patients undergoing transcatheter aortic valve replacement (TAVR).
Methods and results
Multimodality imaging was performed in 197 patients with symptomatic severe AS undergoing TAVR at the University Hospital Zurich, Switzerland. Fusion aortic valve area index (fusion AVAi) assessed by integrating MDCT derived planimetric left ventricular outflow tract area into the continuity equation was significantly larger as compared to conventional AVAi (0.41 ± 0.1 vs. 0.51 ± 0.1 cm2/m2; P < 0.01). A total of 62 patients (31.4%) were reclassified from severe to moderate AS with fusion AVAi being >0.6 cm2/m2. ELI was obtained for conventional AVAi and fusion AVAi based on sinotubular junction area determined by TTE (ELILTL 0.47 ± 0.1 cm2/m2; fusion ELILTL 0.60 ± 0.1 cm2/m2) and MDCT (ELIMDCT 0.48 ± 0.1 cm2/m2; fusion ELIMDCT 0.61 ± 0.05 cm2/m2). When ELI was calculated with fusion AVAi the effective orifice area was >0.6 cm2/m2 in 85 patients (43.1%). Survival rate 3 years after TAVR was higher in patients reclassified to moderate AS according to multimodality imaging derived ELI (78.8% vs. 67%; P = 0.01).
Conclusion
Multimodality imaging derived ELI reclassifies AS severity in 43% undergoing TAVR and predicts mid-term outcome.
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Affiliation(s)
- Erik W Holy
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thi Dan Linh Nguyen-Kim
- Department of Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Lisa Hoffelner
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Daniel Stocker
- Department of Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Stadler
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Julia Kebernik
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiac Surgery, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Markus A Kasel
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Department of Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Lüscher TF. Prevention of non-communicable diseases and special causes of heart failure. Eur Heart J 2015; 36:2019-2022. [DOI: 10.1093/eurheartj/ehv303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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