Application of three-dimensional transesophageal echocardiography in preoperative evaluation of transcatheter aortic valve replacement

Peng Ding, Chennian Xu, Yang Liu, Xin Meng, Ping Jin, Jiayou Tang, Lanlan Li, Yanyan Ma, Jian Yang, Peng Ding, Chennian Xu, Yang Liu, Xin Meng, Ping Jin, Jiayou Tang, Lanlan Li, Yanyan Ma, Jian Yang

Abstract

Background: Our goal was to determine the accuracy of 3-dimensional transesophageal echocardiography (3D-TEE) compared with that of computed tomography (CT) in the preoperative evaluation for transcatheter aortic valve replacement (TAVR) when the errors caused by inconsistent software and method have been eliminated and the representativeness of the sample has been improved. We also investigated the influence of aortic root calcification on the accuracy of 3D-TEE in aortic annulus evaluations.

Methods: Part I: 45 of 233 patients who underwent TAVR in the department of cardiovascular surgery at the Xijing hospital from January 2016 to August 2019 were studied retrospectively. Materialise Mimics software and the multiplanar reconstruction method were used for evaluation, based on 3D-TEE and CT. The annulus area-derived diameter, the annulus perimeter-derived diameter (Dp), the annulus mean diameter, the left ventricular outflow tract Dp diameter, the sinotubular junction (STJ) diameter-Dp, and the aortic sinus diameter were compared and analyzed. Part II: 31 of 233 patients whose 3D-TEE and CT data were well preserved and in the required format were included. HU450 and HU850 were used as indicators to measure the severity of calcification. The Spearman rank correlation and Linear regression were used to analyze the correlation between aortic root calcification and the accuracy of 3D-TEE in aortic annulus measurement.

Results: The measurement results based on 3D-TEE were significantly lower than those obtained using CT (P < 0.05), except for the STJ diameter-Dp in diastole (P = 0.11). The correlation coefficient of the two groups was 0.699-0.954 (P < 0.01), which also indicated a significant correlation between the two groups. A Bland-Altman plot showed that the ordinate values were mostly within the 95% consistency limit; the consistency of the two groups was good. By establishing the linear regression equation, the two groups can be inferred from each other. The Spearman rank correlation analysis and the Linear regression analysis showed that the influence of aortic calcification on the accuracy of the 3D-TEE annulus evaluation was limited.

Conclusions: Although an evaluation based on 3D-TEE underestimated the results, we can deduce CT results from 3D-TEE because the two methods exhibit considerable correlation and consistency.

Trial registration: Name: Surgery and Transcatheter Intervention for Structural Heart Diseases. Number: NCT02917980. URL: https://ichgcp.net/clinical-trials-registry/NCT02917980 .

Keywords: Aortic root sizing; Aortic valve calcification; Computed tomography; Three-dimensional transesophageal echocardiography; Transcatheter aortic valve replacement.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Measurements of the aortic root. A Annulus based on computed tomography (CT) measurements. B Left ventricular outflow tract (LVOT) based on CT measurements. C Sinotubular junction (STJ) based on CT measurements. D Sinus of Valsalva (SOV) based on CT scan. E Annulus based on 3-dimensional transesophageal echocardiography (3D-TEE). (F) LVOT based on 3D-TEE. G STJ based on 3D-TEE. H SOV based on 3D-TEE
Fig. 2
Fig. 2
The screening process of patients
Fig. 3
Fig. 3
Transcatheter aortic valve replacement steps at the Xijing hospital. A–D Insertion of a J-valve via a transapical approach. E–H Inserting a Venus-A valve via a transfemoral approach
Fig. 4
Fig. 4
Linear regression showing high correlations between computed tomography and 3-dimensional-transesophageal echocardiography measurements of the left ventricular outflow tract (LVOT) and the annulus. A LVOT-perimeter-derived in systole. B LVOT-perimeter-derived in diastole. C Annulus-area-derived in systole. D Annulus-area-derived in diastole. E Annulus-perimeter-derived in systole. F Annulus-perimeter-derived in diastole. G Annulus-mean in systole. H Annulus-mean in diastole
Fig. 5
Fig. 5
Bland–Altman plot showing good agreement between computed tomography and 3-dimensional transesophageal echocardiography measurements of the left ventricular outflow tract (LVOT) and annulus. A LVOT-perimeter-derived in systole. B LVOT-perimeter-derived in diastole. C Annulus-area-derived in systole. D Annulus-area-derived in diastole. E Annulus-perimeter-derived in systole. F Annulus-perimeter-dreived in diastole. G Annulus-mean in systole. H Annulus-mean in diastole
Fig. 6
Fig. 6
Bland–Altman plot showing good agreement between computed tomography and 3-dimensional transesophageal echocardiography measurements of the sinotubular junction (STJ) and the sinus of Valsalva (SOV). A STJ-perimeter-derived in systole. B STJ-perimeter-derived in diastole. C SOV-left coronary in systole. D SOV-left coronary in diastole. E SOV-right coronary in systole. F SOV-right coronary in diastole. G SOV-noncoronary in systole. H SOV-noncoronary in diastole
Fig. 7
Fig. 7
After the reciprocal transformation of the computed tomography and 3-dimensional transesophageal echocardiography measurements of the sinotubular junction (STJ) and the sinus of Valsalva (SOV), all the data approximately obeyed the normal distribution. Linear regression shows a high correlation between the two imaging modalities. A STJ-perimeter-derived in systole. B STJ-perimeter-derived in diastole. C SOV-left coronary in systole. D SOV-left coronary in diastole. E SOV-right coronary in systole. F SOV-right coronary in diastole. G SOV-noncoronary in systole. H SOV-noncoronary in diastole

References

    1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–2791. doi: 10.1093/eurheartj/ehx391.
    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–1620. doi: 10.1056/NEJMoa1514616.
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695–1705. doi: 10.1056/NEJMoa1814052.
    1. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O'Hair D, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380:1706–1715. doi: 10.1056/NEJMoa1816885.
    1. Hakim D, Ghimire G, Alli OO, Singh S, Sasse MF, Booker OJ, et al. Large-field intravascular ultrasound for annular sizing and predicting paravalvular regurgitation during TAVR: comparisons with multidetector computed tomography and transoesophageal echocardiography. Eur Heart J Cardiovasc Imaging. 2017;18:1404–1413. doi: 10.1093/ehjci/jew322.
    1. Vaquerizo B, Spaziano M, Alali J, Mylote D, Theriault-Lauzier P, Alfagih R, et al. Three-dimensional echocardiography vs. computed tomography for transcatheter aortic valve replacement sizing. Eur Heart J Cardiovasc Imaging. 2016;17:15–23.
    1. Wystub N, Baz L, Mobius-Winkler S, Porner TC, Goebel B, Hamadanchi A, et al. Aortic annulus measurement with computed tomography angiography reduces aortic regurgitation after transfemoral aortic valve replacement compared to 3-D echocardiography: a single-centre experience. Clin Res Cardiol. 2019;108:1266–1275. doi: 10.1007/s00392-019-01462-6.
    1. Abdelghani M, Cavalcante R, Miyazaki Y, de Winter RJ, Tijssen JG, Sarmento-Leite R, et al. Transcatheter aortic valve implantation for mixed versus pure stenotic aortic valve disease. EuroIntervention. 2017;13:1157–1165. doi: 10.4244/EIJ-D-17-00328.
    1. Schafer U, Schirmer J, Niklas S, Harmel E, Deuschl F, Conradi L. First-in-human implantation of a novel transfemoral selfexpanding transcatheter heart valve to treat pure aortic regurgitation. EuroIntervention. 2017;13:1296–1299. doi: 10.4244/EIJ-D-17-00502.
    1. Wernly B, Eder S, Navarese EP, Kretzschmar D, Franz M, Alushi B, et al. Transcatheter aortic valve replacement for pure aortic valve regurgitation: "on-label" versus "off-label" use of TAVR devices. Clin Res Cardiol. 2019;108:921–930. doi: 10.1007/s00392-019-01422-0.
    1. Tsuneyoshi H, Komiya T, Shimamoto T. Accuracy of aortic annulus diameter measurement: comparison of multi-detector CT, two- and three-dimensional echocardiography. J Card Surg. 2016;31:18–22. doi: 10.1111/jocs.12664.
    1. Genereux P, Kodali SK, Green P, Paradis JM, Daneault B, Rene G, et al. Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria. Am J Cardiol. 2013;111(1):100–105. doi: 10.1016/j.amjcard.2012.08.057.
    1. Willson AB, Webb JG, Freeman M, Wood DA, Gurvitch R, Thompson CR, et al. Computed tomography-based sizing recommendations for transcatheter aortic valve replacement with balloon-expandable valves: comparison with transesophageal echocardiography and rationale for implementation in a prospective trial. J Cardiovasc Comput Tomogr. 2012;6(6):406–414. doi: 10.1016/j.jcct.2012.10.002.
    1. Ng AC, Delgado V, van der Kley F, Shanks M, van de Veire NR, Bertini M, et al. Comparison of aortic root dimensions and geometries before and after transcatheter aortic valve implantation by 2- and 3-dimensional transesophageal echocardiography and multislice computed tomography. Circ Cardiovasc Imaging. 2010;3:94–102. doi: 10.1161/CIRCIMAGING.109.885152.
    1. Khalique OK, Kodali SK, Paradis JM, Nazif TM, Williams MR, Einstein AJ, et al. Aortic annular sizing using a novel 3-dimensional echocardiographic method: use and comparison with cardiac computed tomography. Circ Cardiovasc Imaging. 2014;7:155–163. doi: 10.1161/CIRCIMAGING.113.001153.
    1. Mediratta A, Addetia K, Medvedofsky D, Schneider RJ, Kruse E, Shah AP, et al. 3D echocardiographic analysis of aortic annulus for transcatheter aortic valve replacement using novel aortic valve quantification software: comparison with computed tomography. Echocardiography (Mount Kisco, NY) 2017;34:690–699. doi: 10.1111/echo.13483.
    1. Prihadi EA, van Rosendael PJ, Vollema EM, Bax JJ, Delgado V, Ajmone MN. Feasibility, accuracy, and reproducibility of aortic annular and root sizing for transcatheter aortic valve replacement using novel automated three-dimensional echocardiographic software: comparison with multi-detector row computed tomography. J Am Soc Echocardiog. 2018;31:505–514.e3. doi: 10.1016/j.echo.2017.10.003.
    1. Kato N, Shibayama K, Noguchi M, Makihara Y, Okumura H, Obunai K, et al. Superiority of novel automated assessment of aortic annulus by intraoperative three-dimensional transesophageal echocardiography in patients with severe aortic stenosis: Comparison with conventional cross-sectional assessment. J Cardiol. 2018;72:321–327. doi: 10.1016/j.jjcc.2018.02.017.
    1. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur J Cardio-Thorac. 2012;42:S1–44. doi: 10.1093/ejcts/ezs455.
    1. Grube E, Laborde JC, Gerckens U, Felderhoff T, Sauren B, Buellesfeld L, et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation. 2006;114:1616–1624. doi: 10.1161/CIRCULATIONAHA.106.639450.
    1. Pasupati S, Devlin G, Davis M, Kejriwal N, Jogia P, Liew TV, et al. Transcatheter solution for pure aortic insufficiency. JACC Cardiovasc Imaging. 2014;7:315–318. doi: 10.1016/j.jcmg.2013.11.006.
    1. Seiffert M, Bader R, Kappert U, Rastan A, Krapf S, Bleiziffer S, et al. Initial German experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv. 2014;7:1168–1174. doi: 10.1016/j.jcin.2014.05.014.
    1. Wei L, Liu H, Zhu L, Yang Y, Zheng J, Guo K, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-Valve and early outcome. JACC Cardiovasc Interv. 2015;8:1831–1841. doi: 10.1016/j.jcin.2015.08.021.
    1. Wendt D, Kahlert P, Pasa S, El-Chilali K, Al-Rashid F, Tsagakis K, et al. Transapical transcatheter aortic valve for severe aortic regurgitation: expanding the limits. JACC Cardiovasc Interv. 2014;7:1159–1167. doi: 10.1016/j.jcin.2014.04.016.
    1. Cerillo AG, Griese D, Berti S. Successful percutaneous implantation of symetis ACURATE neo transcatheter aortic bioprosthesis for the treatment of pure aortic regurgitation. Catheter Cardiovasc Interv. 2016;88:319–323. doi: 10.1002/ccd.26402.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa