Core Lab Adjudication of the ACURATE neo2 Hemodynamic Performance Using Computed-Tomography-Corrected Left Ventricular Outflow Tract Area
(2022) In Journal of Clinical Medicine 11(20). p.1-12- Abstract
(1) Background: Hemodynamic assessment of prosthetic heart valves using conventional 2D transthoracic Echocardiography-Doppler (2D-TTE) has limitations. Of those, left ventricular outflow tract (LVOT) area measurement is one of the major limitations of the continuity equation, which assumes a circular LVOT. (2) Methods: This study comprised 258 patients with severe aortic stenosis (AS), who were treated with the ACURATE neo2. The LVOT area and its dependent Doppler-derived parameters, including effective orifice area (EOA) and stroke volume (SV), in addition to their indexed values, were calculated from post-TAVI 2D-TTE. In addition, the 3D-LVOT area from pre-procedural MDCT scans was obtained and used to calculate corrected... (More)
(1) Background: Hemodynamic assessment of prosthetic heart valves using conventional 2D transthoracic Echocardiography-Doppler (2D-TTE) has limitations. Of those, left ventricular outflow tract (LVOT) area measurement is one of the major limitations of the continuity equation, which assumes a circular LVOT. (2) Methods: This study comprised 258 patients with severe aortic stenosis (AS), who were treated with the ACURATE neo2. The LVOT area and its dependent Doppler-derived parameters, including effective orifice area (EOA) and stroke volume (SV), in addition to their indexed values, were calculated from post-TAVI 2D-TTE. In addition, the 3D-LVOT area from pre-procedural MDCT scans was obtained and used to calculate corrected Doppler-derived parameters. The incidence rates of prosthesis patient mismatch (PPM) were compared between the 2D-TTE and MDCT-based methods (3) Results: The main results show that the 2D-TTE measured LVOT is significantly smaller than 3D-MDCT (350.4 ± 62.04 mm2 vs. 405.22 ± 81.32 mm2) (95% Credible interval (CrI) of differences: −55.15, −36.09), which resulted in smaller EOA (2.25 ± 0.59 vs. 2.58 ± 0.63 cm2) (Beta = −0.642 (95%CrI of differences: −0.85, −0.43), and lower SV (73.88 ± 21.41 vs. 84.47 ± 22.66 mL), (Beta = −7.29 (95% CrI: −14.45, −0.14)), respectively. PPM incidence appears more frequent with 2D-TTE- than 3D-MDCT-corrected measurements (based on the EOAi) 8.52% vs. 2.32%, respectively. In addition, significant differences regarding the EOA among the three valve sizes (S, M and L) were seen only with the MDCT, but not on 2D-TTE. (4) Conclusions: The corrected continuity equation by combining the 3D-LVOT area from MDCT with the TTE Doppler parameters might provide a more accurate assessment of hemodynamic parameters and PPM diagnosis in patients treated with TAVI. The ACURATE neo2 THV has a large EOA and low incidence of PPM using the 3D-corrected LVOT area than on 2D-TTE. These findings need further confirmation on long-term follow-up and in other studies.
(Less)
- author
- organization
- publishing date
- 2022-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ACURATE neo2, aortic stenosis, computed tomography, echocardiography, hemodynamic performance, left ventricular outflow tract, prosthesis patient mismatch
- in
- Journal of Clinical Medicine
- volume
- 11
- issue
- 20
- article number
- 6103
- pages
- 1 - 12
- publisher
- MDPI AG
- external identifiers
-
- pmid:36294424
- scopus:85140724103
- ISSN
- 2077-0383
- DOI
- 10.3390/jcm11206103
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2022 by the authors.
- id
- 287b58fb-4e9f-4d28-923f-35a1b83fbb43
- date added to LUP
- 2022-11-07 07:45:14
- date last changed
- 2024-04-17 02:19:18
@article{287b58fb-4e9f-4d28-923f-35a1b83fbb43,
abstract = {{<p>(1) Background: Hemodynamic assessment of prosthetic heart valves using conventional 2D transthoracic Echocardiography-Doppler (2D-TTE) has limitations. Of those, left ventricular outflow tract (LVOT) area measurement is one of the major limitations of the continuity equation, which assumes a circular LVOT. (2) Methods: This study comprised 258 patients with severe aortic stenosis (AS), who were treated with the ACURATE neo2. The LVOT area and its dependent Doppler-derived parameters, including effective orifice area (EOA) and stroke volume (SV), in addition to their indexed values, were calculated from post-TAVI 2D-TTE. In addition, the 3D-LVOT area from pre-procedural MDCT scans was obtained and used to calculate corrected Doppler-derived parameters. The incidence rates of prosthesis patient mismatch (PPM) were compared between the 2D-TTE and MDCT-based methods (3) Results: The main results show that the 2D-TTE measured LVOT is significantly smaller than 3D-MDCT (350.4 ± 62.04 mm<sup>2</sup> vs. 405.22 ± 81.32 mm<sup>2</sup>) (95% Credible interval (CrI) of differences: −55.15, −36.09), which resulted in smaller EOA (2.25 ± 0.59 vs. 2.58 ± 0.63 cm<sup>2</sup>) (Beta = −0.642 (95%CrI of differences: −0.85, −0.43), and lower SV (73.88 ± 21.41 vs. 84.47 ± 22.66 mL), (Beta = −7.29 (95% CrI: −14.45, −0.14)), respectively. PPM incidence appears more frequent with 2D-TTE- than 3D-MDCT-corrected measurements (based on the EOAi) 8.52% vs. 2.32%, respectively. In addition, significant differences regarding the EOA among the three valve sizes (S, M and L) were seen only with the MDCT, but not on 2D-TTE. (4) Conclusions: The corrected continuity equation by combining the 3D-LVOT area from MDCT with the TTE Doppler parameters might provide a more accurate assessment of hemodynamic parameters and PPM diagnosis in patients treated with TAVI. The ACURATE neo2 THV has a large EOA and low incidence of PPM using the 3D-corrected LVOT area than on 2D-TTE. These findings need further confirmation on long-term follow-up and in other studies.</p>}},
author = {{Elkoumy, Ahmed and Rück, Andreas and Kim, Won Keun and Abdel-Wahab, Mohamed and Abdelshafy, Mahmoud and De Backer, Ole and Elzomor, Hesham and Hengstenberg, Christian and Mohamed, Sameh K. and Saleh, Nawzad and Arsang-Jang, Shahram and Bjursten, Henrik and Simpkin, Andrew and Meduri, Christopher U. and Soliman, Osama}},
issn = {{2077-0383}},
keywords = {{ACURATE neo2; aortic stenosis; computed tomography; echocardiography; hemodynamic performance; left ventricular outflow tract; prosthesis patient mismatch}},
language = {{eng}},
number = {{20}},
pages = {{1--12}},
publisher = {{MDPI AG}},
series = {{Journal of Clinical Medicine}},
title = {{Core Lab Adjudication of the ACURATE neo2 Hemodynamic Performance Using Computed-Tomography-Corrected Left Ventricular Outflow Tract Area}},
url = {{http://dx.doi.org/10.3390/jcm11206103}},
doi = {{10.3390/jcm11206103}},
volume = {{11}},
year = {{2022}},
}