Automated and semi-automated 3D echocardiographic software for aortic annulus sizing in transcatheter aortic valve implantation helps bridge the gap between expert and novice operators
Tóm tắt
3D-transesophageal echocardiography (3D-TEE) is an alternative to multidetector row computed tomography (MDCT) for aortic annulus (AoA) sizing in preparation for Transcatheter aortic valve implantation (TAVI). We aim to evaluate how the fully automated (auto) and semi-automated (SA) TEE methods perform compared to conventional manual TEE method and the gold standard MDCT for annulus sizing both in expert and novice operators. In this prospective cohort study, eighty-nine patients with severe aortic stenosis underwent multimodality imaging with 3D-TEE and MDCT. Annular measurements were collected by expert echocardiographers using 3D auto, SA and manual methods and compared to MDCT. A novice in the field of echocardiography retrospectively measured the AoA for all patients using the same methods. TEE measurements, independently of the method used, had good to very good agreement to MDCT. They significantly underestimated aortic annular area and circumference vs. MDCT with the auto method underestimating it the most and the manual method the least (6.5% and 1.3% respectively for area and circumference). For experts, the manual TEE method offered the least systematic bias while the SA method had narrower limits of agreement (LOA). For the novice operator, SA method provided the least bias and narrower LOA vs. MDCT. There is good agreement between novice and experts for all 3 TEE methods but better agreement with auto and SA methods as opposed to manual one. Our study supports the use of 3D-TEE as a complementary method to MDCT for aortic annular sizing. The newer auto and SA software, that requires minimal operator intervention, is an easy to use, reliable and reproducible tool for aortic annulus sizing for experienced operators, and especially less experienced ones.
Tài liệu tham khảo
Smith CR et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198. https://doi.org/10.1056/NEJMoa1103510
Leon MB et al (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374(17):1609–1620. https://doi.org/10.1056/NEJMoa1514616
Reardon MJ et al (2017) “Surgical or transcatheter aortic-valve replacement in intermediate-risk patients,” (in eng). N Engl J Med 376(14):1321–1331. https://doi.org/10.1056/NEJMoa1700456
Mack MJ et al (2019) Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 380(18):1695–1705. https://doi.org/10.1056/NEJMoa1814052
Généreux P et al (2013) “Paravalvular leak after transcatheter aortic valve replacement: the new achilles’ heel? A comprehensive review of the literature,” (in eng). J Am Coll Cardiol 61(11):1125–1136. https://doi.org/10.1016/j.jacc.2012.08.1039
Généreux P, Reiss GR, Kodali SK, Williams MR, Hahn RT (2012) “Periaortic hematoma after transcatheter aortic valve replacement: description of a new complication,” (in eng). Catheter Cardiovasc Interv 79(5):766–776. https://doi.org/10.1002/ccd.23242
Athappan G et al (2013) “Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature,” (in eng). J Am Coll Cardiol 61(15):1585–1595. https://doi.org/10.1016/j.jacc.2013.01.047
Kenny C, Monaghan M (2015) “How to assess aortic annular size before transcatheter aortic valve implantation (TAVI): the role of echocardiography compared with other imaging modalities,” (in eng). Heart 101(9):727–736. https://doi.org/10.1136/heartjnl-2013-304689
Kasel AM et al (2013) “Standardized imaging for aortic annular sizing: implications for transcatheter valve selection,” (in eng). JACC Cardiovasc Imaging 6(2):249–262. https://doi.org/10.1016/j.jcmg.2012.12.005
Willson AB et al (2012) “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,” (in eng). J Cardiovasc Comput Tomogr 6(6):406–414. https://doi.org/10.1016/j.jcct.2012.10.002
Vaquerizo B et al (2016) “Three-dimensional echocardiography vs. computed tomography for transcatheter aortic valve replacement sizing,” (in eng). Eur Heart J Cardiovasc Imaging 17(1):15–23. https://doi.org/10.1093/ehjci/jev238
Stella S et al (2019) “Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection,: (in eng). Eur Heart J Cardiovasc Imaging 20(1):45–55. https://doi.org/10.1093/ehjci/jey013
Queirós S et al (2018) “Validation of a novel software tool for automatic aortic annular sizing in three-dimensional transesophageal echocardiographic images,” (in eng). J Am Soc Echocardiogr 31(4):515-525.e5. https://doi.org/10.1016/j.echo.2018.01.007
Prihadi EA, van Rosendael PJ, Vollema EM, Bax JJ, Delgado V, Ajmone Marsan N (2018) “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,” (in eng). J Am Soc Echocardiogr 31(4):505–514. https://doi.org/10.1016/j.echo.2017.10.003
Jilaihawi H et al (2012) “Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation,” (in eng). J Am Coll Cardiol 59(14):1275–1286. https://doi.org/10.1016/j.jacc.2011.11.045
Bax J et al (2014) Open issues in transcatheter aortic valve implantation. Part 1: patient selection and treatment strategy for transcatheter aortic valve implantation. Europ Heart J. https://doi.org/10.1093/eurheartj/ehu256
D’Ancona G, Dißmann M, Heinze H, Zohlnhöfer-Momm D, Ince H, Kische S (2018) Transcatheter aortic valve replacement with the 34 mm medtronic evolut valve. Neth Heart J 26(7):401–408. https://doi.org/10.1007/s12471-018-1122-4
Kappetein AP et al (2013) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document∗. J Thorac Cardiovasc Surg 145(1):6–23. https://doi.org/10.1016/j.jtcvs.2012.09.002
Mitchell C et al (2019) “Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the american society of echocardiography,” (in eng). J Am Soc Echocardiogr 32(1):1–64. https://doi.org/10.1016/j.echo.2018.06.004
Steyerberg EW (2018) “Validation in prediction research: the waste by data splitting,” (in eng). J Clin Epidemiol 103:131–133. https://doi.org/10.1016/j.jclinepi.2018.07.010
Rong LQ et al (2019) “Three-dimensional echocardiography for transcatheter aortic valve replacement sizing: a systematic review and meta-analysis,” (in eng). J Am Heart Assoc 8(19):e013463. https://doi.org/10.1161/jaha.119.013463
Khalique OK et al (2014) “Aortic annular sizing using a novel 3-dimensional echocardiographic method: use and comparison with cardiac computed tomography,” (in eng). Circ Cardiovasc Imaging 7(1):155–163. https://doi.org/10.1161/circimaging.113.001153
Schultz CJ et al (2010) “Three dimensional evaluation of the aortic annulus using multislice computer tomography: are manufacturer’s guidelines for sizing for percutaneous aortic valve replacement helpful?,” (in eng). Eur Heart J 31(7):849–856. https://doi.org/10.1093/eurheartj/ehp534
Jilaihawi H et al (2013) “Aortic annular sizing for transcatheter aortic valve replacement using cross-sectional 3-dimensional transesophageal echocardiography,” (in eng). J Am Coll Cardiol 61(9):908–916. https://doi.org/10.1016/j.jacc.2012.11.055
Khalique OK et al (2017) “Impact of methodologic differences in three-dimensional echocardiographic measurements of the aortic annulus compared with computed tomographic angiography before transcatheter aortic valve replacement,” (in eng). J Am Soc Echocardiogr 30(4):414–421. https://doi.org/10.1016/j.echo.2016.10.012
García-Martín A et al (2016) “Accuracy and reproducibility of novel echocardiographic three-dimensional automated software for the assessment of the aortic root in candidates for thanscatheter aortic valve replacement,” (in eng). Eur Heart J Cardiovasc Imaging 17(7):772–778. https://doi.org/10.1093/ehjci/jev204
Claessen BE, Tang GHL, Kini AS, Sharma SK (2021) considerations for optimal device selection in transcatheter aortic valve replacement: a review. JAMA Cardiology 6(1):102–112. https://doi.org/10.1001/jamacardio.2020.3682