Echocardiography is inferior to computed tomography in predicting balloon expandable transcutaneous implantation valve size in routine clinical setting-single centre study

Funding Acknowledgements

Type of funding sources: None.

Background

Transcatheter aortic valve replacement (TAVR) became standard of care for selected patients with severe aortic stenosis. Computed tomography (CT) and 2D/3D echocardiography (ECHO) are used for aortic annulus sizing. As a result of increasing number of TAVR more imaging specialists participate in pre-procedural TAVR assessment.

Purpose

The aim of this study was to compare accuracy of ECHO aortic annulus measurements vs CT based parameters for Edward Sapiens TAVR in such environment.

Methods

Data of 145 consecutive patients with TAVR (Sapiens XT or Sapiens 3S) were analysed retrospectively. One radiologist and six echocardiographers trained in aortic annulus size measurements participated in pre-procedural aortic anulus assessment. Aortic annulus area and area derived diameter were measured/calculated in each patient from 3D ECHO data set acquired from mid-oesophageal view and from CT data set, using multiplanar reconstruction. 2D ECHO aortic annulus size was measured from mid-oesophageal 120º view in early systole. 

Results

139 (96%) patients had favourable TAVR result (max. mild aortic regurgitation, single valve implanted). 3D ECHO aortic anulus area and area derived diameter were smaller than corresponding CT parameters (464 ± 99 vs 479 ± 88 mm2, p < 0.001 and 24.2 ± 2.7 mm vs 25.0 ± 5.5, p = 0.002, respectively) and differed between echocardiographers (p < 0.001). 2D ECHO anulus measurement were smaller in comparison to both CT and 3D ECHO area derived diameter (22.6 ± 2.9 vs 25.0 ± 5.5mm, p = 0,013 and 22.6 ± 2.9 vs 24.2± 2.7mm, p < 0.001, respectively). In implanted valves with favourable procedure result, concordance of CT and 3D ECHO aortic annulus area with manufacturer recommended ranges was 79.4% vs 61% (p= 0.001) and for area derived diameter 80.1% vs 61.7% (p = 0.001). Using 3D ECHO measurements 33% of the patients would have hypothetically received inappropriate valve size.

Conclusion

3D ECHO aortic annulus measurements are generally smaller then CT ones. If 3D ECHO based parameters only were used for TAVR (Edward Sapiens) size selection, it would have resulted in underestimation of the valve size in up to 1/3 of the patients. CT aortic annulus size assessment should be preferred method over 3D ECHO in daily practice. Abstract Figure 1  Abstract Table 1

The use of biochemical markers in cardiotoxicity monitoring in patients treated for leukemia

Cardiotoxicity is a serious and relatively frequent complication of anti-tumorous treatment. Anthracyclines represent the greatest risk. Biochemical markers of structural and functional myocardial damage have been gaining ground in cardiotoxicity monitoring. The aim of the study was to monitor cardiotoxicity of induction chemotherapy in acute myeloid leukemia (AML) patients and to assess the potential for use of biochemical markers in early diagnostics of cardiotoxicity. Fifteen consecutive adult patients with a newly diagnosed AML were studied. All patients received induction chemotherapy containing Idarubicin (IDA) 3 x 12 mg/m2 and intermediate doses of Cytarabine (8 x 1.5 g/m2). Serial measurements of plasma N-terminal pro brain natriuretic peptide (NT-proBNP) values were performed at the baseline, the day following each IDA infusion, after 14 days and after circa 1 month, i.e. before the next chemotherapy. Cardio-specific markers (cTnT, CK-MB mass) were measured at the baseline and after the last IDA infusion. The mean baseline value of NT-proBNP in newly diagnosed AML patients was 129.7+/-59.6 pg/ml. The mean NT-proBNP value increased after the first IDA infusion to 307.3+/-171.4 pg/ml (p=0.02). In most of the patients, the second and the third IDA infusions were not associated with a further increase in the NT-proBNP value and levels after 2 and 4 weeks were not significantly different from the baseline. However, in one of the patients the NT-proBNP values were increasing after each IDA infusion (after the last one 786.2 pg/ml) and within 14 days he developed congestive heart failure due to left ventricular diastolic dysfunction as assessed by echocardiography. At that time, the NT-proBNP value was 1,184.0 pg/ml; after diuretics it decreased significantly. In all patients, plasma cTnT and CK-MB mass concentrations were within the reference interval at the baseline and after the induction chemotherapy. Our results suggest that induction chemotherapy in AML (IDA 36 mg/m2 and intermediate doses of Cytarabine): 1. does not cause detectable damage of the myocyte structure, 2. is in all patients associated with acute neurohumoral activation (transient elevation of NT-proBNP) indicating acute subclinical cardiotoxicity, 3. may lead to congestive heart failure and NT-proBNP seems to be a promising early marker and predictor of this complication.

[Syncope in ventricular tachycardia as a first clinical sign of patent ductus arteriosus in an adulthood]

The case-report describes a 48-year-old-female patient with the patent ductus arteriosus with the following structural changes leading to the malignant arrhythmias manifested as a syncope. The patient was treated by Amplatzer occluder and the implantation of the cardioverter-defibrillator. The authors discuss the patent ductus arteriosus, arrhythmias and sudden cardiac death in the patients with the congenital heart disease in an adulthood.

Transport properties of hydrolyzed polyacrylonitrile

Measurements of the permeability coefficients of various compounds up-to a molecular weight of about 70,000 have shown clearly that membranes prepared from hydrolyzed polyacrylonitrile are about 10 times more permeable than those made of poly(2-hydroxyethyl) methacrylate. The higher permeability is probably due more to the higher water content (about 75%) than to the type of network. The high mechanical strength of the membranes and their good permeability to compounds possessing a comparatively high molecular weight seem to designate the material for some new applications in medicine.

Effect of cartilage bone-marrow extract on articular cartilage collagen formation

Cartilage bone-marrow extract has stimulated the collagen formation of articular as well as sternal cartilage collagen in chick embryo. Collagen biosynthesis has been stimulated also in other investigated tissues, i.e. in cornea and sclera of chick embryo as well as in sponge granuloma of rats, where mainly formation of collagen type I was stimulated. Glycosaminoglycans formation has also been increased after administration of cartilage bone-marrow extract.

The effect of diftalone on collagen and glycosaminoglycans metabolism

Diftalone showed a distinct inhibition effect on the collagen formation in sponge granuloma as well as in chick embryos articular cartilage. The inhibitory effect was expressed even in corneal and articular cartilage glycosaminoglycans (GAG) sulphation and GAG formation in granulation tissue. According to our previous results diftalone showed a similar inhibition of collagen and GAG biosynthesis as other effective antirheumatic drugs.

Presence of a non-sulphated glucosaminoglycan in embryonic cornea

An analtical evidence has been obtained for the presence of a non-sulphated glucosaminoglycan in the young embryonic White Leghorn chicken cornea, consisting of nearly equimolar amounts of glucosamine and glucuronic acid. The polysaccharide is supposed to be identical with hyaluronic acid.