Impact of stroke volume assessment by integrating multi-detector computed tomography and Doppler data on the classification of aortic stenosis

Male Echocardiography, Three-Dimensional 610 Medicine & health 2705 Cardiology and Cardiovascular Medicine Transcatheter Aortic Valve Replacement 03 medical and health sciences Multi 0302 clinical medicine Multidetector Computed Tomography Humans Aged Aged, 80 and over 10042 Clinic for Diagnostic and Interventional Radiology Aortic stenosis Reproducibility of Results Stroke Volume Aortic Valve Stenosis Echocardiography, Doppler 10020 Clinic for Cardiac Surgery ROC Curve Echocardiography Aortic Valve Heart Valve Prosthesis detector computed tomography 10209 Clinic for Cardiology Female
DOI: 10.1016/j.ijcard.2017.03.112 Publication Date: 2017-09-01T14:49:19Z
ABSTRACT
The prevalence of low flow low gradient (LFLG) severe aortic stenosis (AS) may be overrated due to underestimation of stroke volume in two-dimensional (2D) echocardiography. The implications of 3D imaging on stroke volume calculation for AS classification have not been elucidated. Integrating multi-detector computed tomography (MDCT) and Doppler data may improve diagnostic accuracy in patients with LFLG AS.A total of 186 patients with severe AS evaluated for transcatheter aortic valve replacement were classified according to indexed stroke volume (SVI, cut-off 35mL/m2) and mean transaortic pressure gradient (cut-off 40mmHg). SVI was calculated using a) the biplane Simpson's method, b) left ventricular outflow tract (LVOT) velocity time integral (VTI) and LVOT diameter determined by 2D echocardiography, or c) LVOT VTI and LVOT area planimetered by MDCT.SVI assessed by the biplane Simpson's method was smaller than that obtained from 2D echocardiography LVOT diameter (29.5±0.6 vs 34.9±0.8mL/m2, p<0.001). The latter was smaller than SVI calculated by integrating MDCT and Doppler data (47.5±1.4mL/m2, p<0.001). LFLG and paradoxical LFLG severe AS were diagnosed in 42.5% and 27.4% of patients using the biplane Simpson's method, in 30.1% and 16.7% using 2D echocardiography LVOT diameter, and in 17.2% and 8.1% when integrating MDCT and Doppler data.The prevalence of LFLG and paradoxical LFLG severe AS was overestimated by 2.5- and 3.4-fold based on 2D echocardiography alone. Integration of MDCT and Doppler data should be considered for stroke volume assessment in the classification of severe AS.
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