- 作者：Hasan Jilaihawi ; MD ; Niraj Doctor ; MBBS ; Mohammad Kashif ; MD ; Tarun Chakravarty ; MD ; Asim Rafique ; MD ; Moody Makar ; MD ; Azusa Furugen ; MD ; PhD ; Mamoo Nakamura ; MD ; James Mirocha ; MS ; Mitch Gheorghiu ; MD ; Jasminka Stegic ; MS ; ANP-BC ; CCRN ; ACNP ; Kazuaki Okuyama ; MD ; Daniel J. Sullivan ; MD ; Robert Siegel ; MD ; James K. Min ; MD ; Swaminatha V. Gurudevan ; MD ; Gregory P. Fontana ; MD ; Wen Cheng ; MD ; Gerald Friede ; BS ; MS ; Takahiro Shiota ; MD ; Raj R. Makkar ; MD ; raj.makkar@cshs.org
- 关键词：computed tomography ; paravalvular aortic regurgitation ; 3D echocardiography ; transcatheter aortic valve implantation ; transcatheter aortic valve replacement
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：5 March, 2013
- 年：2013
- 卷：61
- 期：9
- 页码：908-916
- 全文大小：2812 K
Objectives
This study compared cross-sectional three-dimensional (3D) transesophageal echocardiography (TEE) to two-dimensional (2D) TEE as methods for predicting aortic regurgitation after transcatheter aortic valve replacement (TAVR).Background
Data have shown that TAVR sizing using cross-sectional contrast computed tomography (CT) parameters is superior to 2D-TEE for the prediction of paravalvular aortic regurgitation (AR). Three-dimensional TEE can offer cross-sectional assessment of the aortic annulus but its role for TAVR sizing has been poorly elucidated.
Methods
All patients had severe symptomatic aortic stenosis and were treated with balloon-expandable TAVR in a single center. Patients studied had both 2D-TEE and 3D imaging (contrast CT and/or 3D-TEE) of the aortic annulus at baseline. Receiver-operating characteristic curves were generated for each measurement parameter using post-TAVR paravalvular AR moderate or greater as the state variable.
Results
For the 256 patients studied, paravalvular AR moderate or greater occurred in 26 of 256 (10.2 % ) of patients. Prospectively recorded 2D-TEE measurements had a low discriminatory value (area under the curve = 0.52, 95 % confidence interval: 0.40 to 0.63, p = 0.75). Average cross-sectional diameter by CT offered a high degree of discrimination (area under the curve = 0.82, 95 % confidence interval: 0.73 to 0.90, p < 0.0001) and mean cross-sectional diameter by 3D-TEE was of intermediate value (area under the curve = 0.68, 95 % confidence interval: 0.54 to 0.81, p = 0.036).
Conclusions
Cross-sectional 3D echocardiographic sizing of the aortic annulus dimension offers discrimination of post-TAVR paravalvular AR that is significantly superior to that of 2D-TEE. Cross-sectional data should be sought from 3D-TEE if good CT data are unavailable for TAVR sizing.