Department updates» Go to news main
Dynamism of the aortic annulus: effect of diastolic vs. systolic CT annular measurements on device selection in transcatheter aortic valve replacement
Murphy DT1, Blanke P2, Alaamri S3, Naoum C4, Rubinshtein R5, Pache G6, Precious B7, Berger A8, Raju R9, Dvir D10, Wood DA11, Webb J12, Leipsic JA13.
See full publication
Annular dimensions, including cross-sectional area, perimeter and subsequently derived diameters, are subject to dynamic changes throughout the cardiac cycle. There is ongoing controversy as to whether perimeter measurement changes between systole and diastole are too small to impact on valve sizing.
To assess both the variability of aortic annular dimensions throughout the cardiac cycle across a range of sub-annular calcification using computed tomography (CT) and the impact of this variability on device size selection for balloon-expandable valves in a large, all-comer multi-center cohort.
ECG-gated CT data of 507 patients (mean 81 ± 7.5 years, 60.1% male) were analyzed in this retrospective, multicenter analysis. Aortic annulus dimensions were assessed on pre-specified systolic and diastolic phases by planimetry, yielding both area and perimeter. Contour smoothing was employed to avoid artificial increase in perimeter values by uneven contours. The extent of subannular calcification was graded semi-quantitatively and assessed in relation to the degree of annular dynamism. Hypothetical device sizing was undertaken to assess the impact of using systolic and diastolic measurements on valve selection.
Mean annular dimensions were larger during systole than diastole (area: 474.4 ± 87.4 mm(2) vs. 438.3 ± 84.3 mm(2) or 8.23%, p < 0.001; perimeter: 78.5 ± 7.2 mm vs. 75.9 ± 7.2 mm or 3.36%, p < 0.001). The magnitude of annular area and perimeter change (systolic minus diastolic measurement) was greater among patients without calcification compared to patients with grade 3 calcification. Using diastolic rather than systolic data for device sizing resulted in a change of the recommended valve size in nearly half of patients for both annular area and perimeter.
The systematic differences between systolic and diastolic annular measurements for cross-sectional area and perimeter have implications for device sizing with potential for valve under-sizing if diastolic annular dimensions are employed.
Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
- Dalhousie Radiology outperforms again at the Canadian Association of Radiologists Annual Meeting
- Angiographic results of surgical or endovascular treatment of intracranial aneurysms: a systematic review and inter‑observer reliability study
- The Many Care Models to Treat Thoracic Aortic Disease in Canada – A Nationwide Survey of Cardiac Surgeons, Cardiologists, Interventional Radiologists and Vascular Surgeons
- Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter‑ and Intraobserver Study
- Magnetic Resonance Imaging Based Radiomic Models of Prostate Cancer: A Narrative Review
- INOVAIT Funding Award
- The role of epidemiologists in SARS‑CoV‑2 and COVID‑19 research
- Evaluation of Golden‑Angle‑Sampled Dynamic Contrast‑Enhanced MRI Reconstruction Using Objective Image Quality Measures: A Simulated Phantom Study
comments powered by Disqus