Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography

Abstract

Degenerative aortic valve stenosis (AS) has an incidence of 2-7% in the Western European and North American populations over 65 years of age. The aim of this study was to perform a meta-analysis of the published literature evaluating the accuracy of CT planimetry to measure the aortic valve area. The PUBMED and OVID databases were searched up to May 2008. Major criteria for article inclusion was the use of (a) multi-detector computed tomography as a diagnostic test for the assessment of AVA in patients with AS, and (b) TTE as the reference standard. Nine studies were included in the analysis with 175 women and 262 men. The mean AVA as measured by CT was 1.0 +/- 0.1. The mean AVA measured by TTE was 0.9 +/- 0.1. The correlation between CT and TTE AVA measurements was r = 1.45. The mean difference was 0.03 +/- 0.05. The results of our meta-analysis suggest that multi-detector CT is an accurate method for obtaining AVA measurements in patients with AS.

Evaluation of valvular disease by cardiac computed tomography assessment

“…Studies have shown that the valve area is largest during mid-systole 7 with other studies suggesting that the optimal phases correspond to 10%-30% of the R-R interval. [8][9][10] Shah et al 7 concluded that MDCT can provide accurate assessment of aortic valve area compared with TEE and is valuable when the latter is inconclusive.…”

Korean Guidelines for the Appropriate Use of Cardiac CT

“…However, when echocardiography is difficult to perform or is limited in its images, cardiac CT can play a supplementary role in diagnosis. In cases of aortic stenosis, previous studies have shown that the area of the aortic valve opening measured on CT is closely associated with the opening area measured on echocardiography (224, 225, 226). Also, by performing CT, it is possible to accurately diagnose abnormalities such as the bicuspid aortic valve (227, 228).…”

The art of assessing aortic stenosis

“…However, it can image the anatomical orifice at sub-0.6 mm resolution with 3D isotropic imaging at any stage of the cardiac cycle to produce an estimate of geometric orifice area. This correlates with but inevitably overestimates EOA calculated echocardiographically 23. In a recent meta-analysis of nine studies involving a total of 437 patients, the mean geometric orifice area measured by MDCT was 1.0±0.1 cm 2 compared with a mean EOA of 0.9±0.1 cm 2 measured by TTE 23…”