Dataset Information

Assessment of aortic valve area on cardiac computed tomography in symptomatic bicuspid aortic stenosis: Utility and differences from Doppler echocardiography.

ABSTRACT:

Background

In this study, we investigate the utility of geometric orifice area (GOA) on cardiac computed tomography (CT) and differences from effective orifice area (EOA) on Doppler echocardiography in patients with bicuspid aortic stenosis (AS).

Methods

A total of 163 patients (age 64 ± 10 years, 56.4% men) with symptomatic bicuspid AS who were referred for surgery and underwent both cardiac CT and echocardiography within 3 months were studied. To calculate the aortic valve area, GOA_CT was measured by multiplanar CT planimetry, and EOA_Echo was calculated by the continuity equation with Doppler echocardiography. The relationships between GOA_CT and EOA_Echo and patient symptom scale, biomarkers, and left ventricular (LV) functional variables were analyzed.

Results

There was a significant but modest correlation between EOA_Echo and GOA_CT (r = 0.604, p < 0.001). Both EOA_Echo and GOA_CT revealed significant correlations with mean pressure gradient and peak transaortic velocity, and the coefficients were higher in EOA_Echo than in GOA_CT. EOA_Echo of 1.05 cm² and GOA_CT of 1.25 cm² corresponds to hemodynamic cutoff values for diagnosing severe AS. EOA_Echo was well correlated with the patient symptom scale and log NT-pro BNP, but GOA_CT was not. In addition, EOA_Echo had a higher correlation coefficient with estimated LV filling pressure and LV global longitudinal strain than GOA_CT.

Conclusion

GOA_CT can be used to evaluate the severity of bicuspid AS. The threshold for GOA_CT for diagnosing severe AS should be higher than that for EOA_Echo. However, EOA_Echo is still the method of choice because EOA_Echo showed better correlations with clinical and functional variables than GOA_CT.

SUBMITTER: Kim K

PROVIDER: S-EPMC9807240 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Assessment of aortic valve area on cardiac computed tomography in symptomatic bicuspid aortic stenosis: Utility and differences from Doppler echocardiography.

Kim Kyu K Lee Soo Ji SJ Seo Jiwon J Suh Young Joo YJ Cho Iksung I Hong Geu-Ru GR Ha Jong-Won JW Kim Young Jin YJ Shim Chi Young CY

Frontiers in cardiovascular medicine 20221219

<h4>Background</h4>In this study, we investigate the utility of geometric orifice area (GOA) on cardiac computed tomography (CT) and differences from effective orifice area (EOA) on Doppler echocardiography in patients with bicuspid aortic stenosis (AS).<h4>Methods</h4>A total of 163 patients (age 64 ± 10 years, 56.4% men) with symptomatic bicuspid AS who were referred for surgery and underwent both cardiac CT and echocardiography within 3 months were studied. To calculate the aortic valve area, ...[more]

PMID: 36601069

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Project description:ImportanceThe outcomes of transcatheter aortic valve replacement (TAVR) in low-risk patients with bicuspid aortic valve stenosis have not been studied in a large scale, multicentered, prospective fashion.ObjectiveTo evaluate the procedural safety, efficacy, and 30-day outcomes of TAVR in patients with bicuspid aortic stenosis at low surgical risk.Design, setting, and participantsThe Low Risk Bicuspid Study is a prospective, single-arm trial study with inclusion/exclusion criteria developed from the Evolut Low Risk Randomized Trial. Follow-up is planned for 10 years. Patients underwent TAVR at 25 centers in the United States who were also participating in the Evolut Low Risk Randomized Trial from December 2018 to October 2019. Eligible patients had severe bicuspid aortic valve stenosis and met American Heart Association/American College of Cardiology guideline indications for aortic valve replacement.InterventionsPatients underwent attempted implant of an Evolut or Evolut PRO transcatheter aortic valve, with valve size based on annular measurements.Main outcomes and measuresThe prespecified primary end point was the incidence of all-cause mortality or disabling stroke at 30 days. The prespecified primary efficacy end point was device success defined as the absence of procedural mortality, the correct position of 1 bioprosthetic heart valve in the proper anatomical location, and the absence of more than mild aortic regurgitation postprocedure.ResultsA total of 150 patients underwent an attempted implant. Baseline characteristics include mean age of 70.3 (5.5) years, 48.0% female (n = 72), and a mean Society of Thoracic Surgeons score of 1.4 (0.6%). Most patients (136; 90.7%) had Sievers type I valve morphology. The incidence of all-cause mortality or disabling stroke was 1.3% (95% CI, 0.3%-5.3%) at 30 days. The device success rate was 95.3% (95% CI, 90.5%-98.1%). At 30 days, the mean (SD) AV gradient was 7.6 (3.7) mm Hg and effective orifice area was 2.3 (0.7) cm2. A new permanent pacemaker was implanted in 22 patients (15.1%). No patients had greater than mild paravalvular leak.Conclusions and relevanceTranscatheter aortic valve replacement in low-surgical risk patients with bicuspid aortic valve stenosis achieved favorable 30-day results, with low rates of death and stroke and high device success rate.Trial registrationClinicalTrials.gov Identifier: NCT03635424.

Dataset Information

Assessment of aortic valve area on cardiac computed tomography in symptomatic bicuspid aortic stenosis: Utility and differences from Doppler echocardiography.

Background

Methods

Results

Conclusion

Publications

Assessment of aortic valve area on cardiac computed tomography in symptomatic bicuspid aortic stenosis: Utility and differences from Doppler echocardiography.

Similar Datasets

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