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Core Lab Adjudicati...
Core Lab Adjudication of the ACURATE neo2 Hemodynamic Performance Using Computed-Tomography-Corrected Left Ventricular Outflow Tract Area
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- Elkoumy, Ahmed (author)
- Galway University Hospital
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- Rück, Andreas (author)
- Karolinska Institutet,Karolinska University Hospital
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- Kim, Won Keun (author)
- Max Planck Institute for Heart and Lung Research
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- Abdel-Wahab, Mohamed (author)
- Leipzig University
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- Abdelshafy, Mahmoud (author)
- Galway University Hospital
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- De Backer, Ole (author)
- Copenhagen University Hospital
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- Elzomor, Hesham (author)
- Galway University Hospital
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- Hengstenberg, Christian (author)
- Medical University of Vienna
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- Mohamed, Sameh K. (author)
- Galway University Hospital
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- Saleh, Nawzad (author)
- Karolinska Institutet,Karolinska University Hospital
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- Arsang-Jang, Shahram (author)
- Galway University Hospital
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- Bjursten, Henrik (author)
- Lund University,Lunds universitet,Skonsammare hjärtkirurgi,Forskargrupper vid Lunds universitet,Less invasive cardiac surgery,Lund University Research Groups,Skåne University Hospital
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- Simpkin, Andrew (author)
- National University of Ireland Galway
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- Meduri, Christopher U. (author)
- Karolinska University Hospital
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- Soliman, Osama (author)
- Galway University Hospital
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(creator_code:org_t)
- 2022-10-17
- 2022
- English.
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In: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 11:20, s. 1-12
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http://dx.doi.org/10... (free)
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Abstract
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- (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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)
Keyword
- ACURATE neo2
- aortic stenosis
- computed tomography
- echocardiography
- hemodynamic performance
- left ventricular outflow tract
- prosthesis patient mismatch
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Elkoumy, Ahmed
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Rück, Andreas
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Kim, Won Keun
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Abdel-Wahab, Moh ...
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Abdelshafy, Mahm ...
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De Backer, Ole
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Elzomor, Hesham
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Hengstenberg, Ch ...
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Mohamed, Sameh K ...
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Saleh, Nawzad
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Arsang-Jang, Sha ...
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Bjursten, Henrik
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Simpkin, Andrew
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Meduri, Christop ...
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Soliman, Osama
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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Lund University
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Karolinska Institutet