Impact of observer experience on multi-detector computed tomography aortic valve morphology assessment and valve size selection for transcatheter aortic valve replacement

Evertz, Ruben; Hub, Sebastian; Kowallick, Johannes T.; Seidler, Tim; Danner, Bernhard C.; Hasenfuß, Gerd; Toischer, Karl; Schuster, Andreas

doi:10.1038/s41598-022-23936-w

Cited by 6 publications

(2 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Structures relevant for TAVR planning were assessed as recommended by current expert consensus 13 . All data were analysed using a dedicated software (3mensio Structural Heart V9.1, Pie Medical Imaging, Maastricht, the Netherlands) 14 . As previously recommended, an individual threshold of the Hounsfield units (HU) was used to distinguish between calcium and contrast medium 8,15 .…”

Section: Methodsmentioning

confidence: 99%

“…13 All data were analysed using a dedicated software (3mensio Structural Heart V9.1, Pie Medical Imaging, Maastricht, the Netherlands). 14 As previously recommended, an individual threshold of the Hounsfield units (HU) was used to distinguish between calcium and contrast medium. 8,15 An empirical threshold of 550 HU was used and adjusted as appropriate according to Ludwig et al 8 AVC was defined as calcification within the valve leaflets, aortic annulus, or aortic wall up to the sinotubular junction.…”

Section: Multidetector Computed Tomographymentioning

confidence: 99%

See 1 more Smart Citation

Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement

et al. 2023

Self Cite

View full text Add to dashboard Cite

Aims There is evidence to suggest that the subtype of aortic stenosis (AS), the degree of myocardial fibrosis (MF), and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Because little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as their association with adverse cardiac events following transcatheter aortic valve replacement (TAVR). Methods and resultsOne hundred consecutive patients with severe AS and indication for TAVR were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multidetector computed tomography, and left ventricular endomyocardial biopsies at the time of TAVR. The final study cohort consisted of 92 patients with a completed study protocol, 39 (42.4%) of whom showed a normal ejection fraction (EF) high-gradient (NEFHG) AS, 13 (14.1%) a low EF high-gradient (LEFHG) AS, 25 (27.2%) a low EF low-gradient (LEFLG) AS, and 15 (16.3%) a paradoxical low-flow, low-gradient (PLFLG) AS. The high-gradient phenotypes (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421 and 813 ± 281 mm 3 , respectively) as compared with the low-gradient phenotypes (LEFLG and PLFLG; 503 ± 326 and 555 ± 594 mm 3 , respectively, P < 0.05). Conversely, MF was most prevalent in low-output phenotypes (LEFLG > LEFHG > PLFLG > NEFHG, P < 0.05). This was paralleled by a greater cardiovascular (CV) mortality within 600 days after TAVR (LEFLG 28% > PLFLG 26.7% > LEFHG 15.4% > NEFHG 2.5%; P = 0.023). In patients with a high MF burden, a higher AVC was associated with a lower mortality following TAVR (P = 0.045, hazard ratio 0.261, 95% confidence interval 0.07-0.97). Conclusions MF is associated with adverse CV outcome following TAVR, which is most prevalent in low EF situations. In the presence of large MF burden, patients with large AVC have better outcome following TAVR. Conversely, worse outcome in large MF and relatively little AVC may be explained by a relative prominence of an underlying cardiomyopathy. The better survival rates in large AVC patients following TAVR indicate TAVR induced relief of severe AS-associated pressure overload with subsequently improved outcome.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Multidetector Computed Tomographymentioning

confidence: 99%

Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

Epicardial adipose tissue as an independent predictor of long-term outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Schulz,

Beuthner,

Böttiger

et al. 2024

Clin Res Cardiol

View full text Add to dashboard Cite

Background Accurate risk stratification is important to improve patient selection and outcome of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). As epicardial adipose tissue (EAT) is discussed to be involved in cardiovascular disease, it could be useful as a marker of poor prognosis in patients with severe AS undergoing TAVR. Methods A total of 416 patients diagnosed with severe AS by transthoracic echocardiography were assigned for TAVR and enrolled for systematic assessment. Patients underwent clinical surveys and 5-year long-term follow-up, with all-cause mortality as the primary endpoint. EAT volume was quantified on pre-TAVR planning CTs. Patients were retrospectively dichotomized at the median of 74 cm3 of EAT into groups with low EAT and high EAT volumes. Mortality rates were compared using Kaplan-Meyer plots and uni- and multivariable cox regression analyses. Results A total number of 341 of 416 patients (median age 80.9 years, 45% female) were included in the final analysis. Patients with high EAT volumes had similar short-term outcome (p = 0.794) but significantly worse long-term prognosis (p = 0.023) compared to patients with low EAT volumes. Increased EAT volumes were associated with worse long-term outcome (HR1.59; p = 0.031) independently from concomitant cardiovascular risk factors, general type of AS, and functional echocardiography parameters of AS severity (HR1.69; p = 0.013). Conclusion Increased EAT volume is an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR. It can be easily obtained from pre-TAVR planning CTs and may thus qualify as a novel marker to improve prognostication and management of patient with severe AS. Trial registration DRKS, DRKS00024479. Graphical abstract AS, aortic stenosis; TAVR, transcatheter aortic valve replacement; EAT, epicardial adipose tissue

show abstract

Clinical Advances in Cardiovascular Computed Tomography: From Present Applications to Promising Developments

Schulz,

Otton,

Hussain

et al. 2024

Curr Cardiol Rep

View full text Add to dashboard Cite

Purpose of the Review This review aims to provide a profound overview on most recent studies on the clinical significance of Cardiovascular Computed Tomography (CCT) in diagnostic and therapeutic pathways. Herby, this review helps to pave the way for a more extended but yet purposefully use in modern day cardiovascular medicine. Recent Findings In recent years, new clinical applications of CCT have emerged. Major applications include the assessment of coronary artery disease and structural heart disease, with corresponding recommendations by major guidelines of international societies. While CCT already allows for a rapid and non-invasive diagnosis, technical improvements enable further in-depth assessments using novel imaging parameters with high temporal and spatial resolution. Those developments facilitate diagnostic and therapeutic decision-making as well as improved prognostication. Summary This review determined that recent advancements in both hardware and software components of CCT allow for highly advanced examinations with little radiation exposure. This particularly strengthens its role in preventive care and coronary artery disease. The addition of functional analyses within and beyond coronary artery disease offers solutions in wide-ranging patient populations. Many techniques still require improvement and validation, however, CCT possesses potential to become a “one-stop-shop” examination.

show abstract

Impact of observer experience on multi-detector computed tomography aortic valve morphology assessment and valve size selection for transcatheter aortic valve replacement

Cited by 6 publications

References 30 publications

Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement

Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement

Epicardial adipose tissue as an independent predictor of long-term outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Clinical Advances in Cardiovascular Computed Tomography: From Present Applications to Promising Developments

Contact Info

Product

Resources

About