Joanna Bartkowiak MD , Chrisoula Dernektsi MD , Vratika Agarwal MD , Mark A. Lebehn MD , Treena A. Williams MS , Russel A. Brandwein MS , Nicolas Brugger MD , Christoph Gräni MD , Stephan Windecker MD , Torsten P. Vahl MD , Tamim M. Nazif MD , Isaac George MD , Susheel K. Kodali MD , Fabien Praz MD , Rebecca T. Hahn MD
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Hahn MD","doi":"10.1016/j.jcmg.2024.05.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>New postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo–left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR).</div></div><div><h3>Objectives</h3><div>This study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT).</div></div><div><h3>Methods</h3><div>A total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients.</div></div><div><h3>Results</h3><div>There was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm<sup>2</sup>, limit of agreement: −92.2 mm<sup>2</sup> to 143.3 mm<sup>2</sup>; <em>P</em> < 0.001; mean bias pre/post CT: 28.3 mm<sup>2</sup>, limit of agreement: −65.8 mm<sup>2</sup> to 122.4 mm<sup>2</sup>; <em>P =</em> 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r<sup>2</sup> = 0.481; <em>P</em> < 0.001 for TEE and r<sup>2</sup> = 0.401; <em>P</em> < 0.001 for CT).</div></div><div><h3>Conclusions</h3><div>TEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1168-1178"},"PeriodicalIF":12.8000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"3-Dimensional Echocardiographic Prediction of Left Ventricular Outflow Tract Area Prior to Transcatheter Mitral Valve Replacement\",\"authors\":\"Joanna Bartkowiak MD , Chrisoula Dernektsi MD , Vratika Agarwal MD , Mark A. Lebehn MD , Treena A. Williams MS , Russel A. Brandwein MS , Nicolas Brugger MD , Christoph Gräni MD , Stephan Windecker MD , Torsten P. Vahl MD , Tamim M. Nazif MD , Isaac George MD , Susheel K. Kodali MD , Fabien Praz MD , Rebecca T. Hahn MD\",\"doi\":\"10.1016/j.jcmg.2024.05.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>New postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo–left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR).</div></div><div><h3>Objectives</h3><div>This study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT).</div></div><div><h3>Methods</h3><div>A total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients.</div></div><div><h3>Results</h3><div>There was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm<sup>2</sup>, limit of agreement: −92.2 mm<sup>2</sup> to 143.3 mm<sup>2</sup>; <em>P</em> < 0.001; mean bias pre/post CT: 28.3 mm<sup>2</sup>, limit of agreement: −65.8 mm<sup>2</sup> to 122.4 mm<sup>2</sup>; <em>P =</em> 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r<sup>2</sup> = 0.481; <em>P</em> < 0.001 for TEE and r<sup>2</sup> = 0.401; <em>P</em> < 0.001 for CT).</div></div><div><h3>Conclusions</h3><div>TEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.</div></div>\",\"PeriodicalId\":14767,\"journal\":{\"name\":\"JACC. 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Cardiovascular imaging","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1936878X24002018","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
3-Dimensional Echocardiographic Prediction of Left Ventricular Outflow Tract Area Prior to Transcatheter Mitral Valve Replacement
Background
New postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo–left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR).
Objectives
This study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT).
Methods
A total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients.
Results
There was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm2, limit of agreement: −92.2 mm2 to 143.3 mm2; P < 0.001; mean bias pre/post CT: 28.3 mm2, limit of agreement: −65.8 mm2 to 122.4 mm2; P = 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r2 = 0.481; P < 0.001 for TEE and r2 = 0.401; P < 0.001 for CT).
Conclusions
TEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.
期刊介绍：
JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography.
JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy.
In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.
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