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Aortic valve area assessed with 320-detector computed tomography: comparison with transthoracic echocardiography

  • Linnea Hornbech LarsenEmail author
  • Klaus Fuglsang Kofoed
  • Helle Gervig Carstensen
  • Mads Rams Mejdahl
  • Mads Jønsson Andersen
  • Jesper Kjaergaard
  • Olav Wendelboe Nielsen
  • Lars Køber
  • Rasmus Møgelvang
  • Christian Hassager
Original Paper

Abstract

To evaluate the diagnostic accuracy of aortic valve area (AVA) assessment with 320-detector Computed Tomography (MDCT) compared to transthoracic echocardiography (TTE) in a population with mild to severe aortic valve stenosis. AVA was estimated in 169 patients by planimetry on MDCT images (AVAMDCT) and by the continuity equation with TTE (AVATTE). To generate a reference AVA (AVAREF) we used the stroke volume from MDCT divided by the velocity time integral from CW Doppler by TTE (according to the continuity equation: stroke volume in LVOT = stroke volume passing the aortic valve). AVAREF was used as the reference to compare both measures against, since it bypasses the assumption of LVOT being circular in the continuity equation and the potential placement error of PW Doppler in the LVOT. The mean (±SD) age of the patients was 71 (±9) years, 113 (67 %) were males. Mean AVATTE was 0.93 (±0.33) cm2, mean AVAMDCT was 0.99 (±0.36) cm2 and mean AVAREF was 1.00 (±0.39) cm2. The mean difference between AVATTE and AVAMDCT was −0.06 cm2, p = 0.001, mean difference between AVATTE and AVAREF was −0.06 cm2, p < 0.001, and mean difference between AVAMDCT and AVAREF was −0.01 cm2, p = 0.60. Calcification of the aortic valve quantified by Agatston score, significantly decreased the correlation between AVAMDCT and AVAREF, (r low Agatston = 0.90, r high Agatston = 0.57). MDCT measured AVA is slightly larger than AVA measured by TTE (0.06 cm2). The accuracy and precision errors on AVA measurements are comparable for MDCT and TTE. Valvular calcification may primarily affect the accuracy of AVAMDCT.

Keywords

Aortic valve area Multi-detector computed tomography 320-Detector computed tomography Transthoracic echocardiography Aortic valve stenosis Aortic valve calcification 

Abbreviations

TTE

Transthoracic echocardiography

MDCT

Multi-detector computed tomography

TAVI

Transcatheter aortic valve implantation

AVA

Aortic valve area

Bpm

Beats per minute

LVOT

Left ventricular outflow tract

SV

Stroke volume

VTI

Velocity time integral

LOA

Limits of agreement

Notes

Acknowledgments

This work was supported by The Danish Heart Association, Tove and John Girotti’s Fond, and the A.P Møller and wife Chastine McKinney Møllers Foundation, Denmark.

Conflict of interest

Dr. Kofoed has received lecture fees from the Toshiba Medical Systems Corporation.

References

  1. 1.
    Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H et al (2012) Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg  33:2451–2496Google Scholar
  2. 2.
    Leipsic J, Gurvitch R, Labounty TM, Min JK, Wood D, Johnson M et al (2011) Multidetector computed tomography in transcatheter aortic valve implantation. JACC Cardiovasc Imaging 4(4):416–429PubMedCrossRefGoogle Scholar
  3. 3.
    Feuchtner GM, Dichtl W, Friedrich GJ, Frick M, Alber H, Schachner T et al (2006) Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity. J Am Coll Cardiol 47(7):1410–1417PubMedCrossRefGoogle Scholar
  4. 4.
    Alkadhi H, Wildermuth S, Plass A, Bettex D, Baumert B, Leschka S et al (2006) Aortic stenosis: comparative evaluation of 16-detector row CT and echocardiography. Radiology 240(1):47–55PubMedCrossRefGoogle Scholar
  5. 5.
    Pouleur AC, le Polain de Waroux JB, Pasquet A, Vanoverschelde JL, Gerber BL (2007) Aortic valve area assessment: multidetector CT compared with cine MR imaging and transthoracic and transesophageal echocardiography. Radiology 244(3):745–754PubMedCrossRefGoogle Scholar
  6. 6.
    Laissy JP, Messika-Zeitoun D, Serfaty JM, Sebban V, Schouman-Claeys E, Iung B et al (2007) Comprehensive evaluation of preoperative patients with aortic valve stenosis: usefulness of cardiac multidetector computed tomography. Heart 93(9):1121–1125PubMedCrossRefGoogle Scholar
  7. 7.
    Feuchtner GM, Muller S, Bonatti J, Schachner T, Velik-Salchner C, Pachinger O et al (2007) Sixty-four slice CT evaluation of aortic stenosis using planimetry of the aortic valve area. AJR Am J Roentgenol 189(1):197–203PubMedCrossRefGoogle Scholar
  8. 8.
    Tanaka H, Shimada K, Yoshida K, Jissho S, Yoshikawa J, Yoshiyama M (2007) The simultaneous assessment of aortic valve area and coronary artery stenosis using 16-slice multidetector-row computed tomography in patients with aortic stenosis comparison with echocardiography. Circ J 71(10):1593–1598PubMedCrossRefGoogle Scholar
  9. 9.
    Lembcke A, Thiele H, Lachnitt A, Enzweiler CN, Wagner M, Hein PA et al (2008) Precision of forty slice spiral computed tomography for quantifying aortic valve stenosis: comparison with echocardiography and validation against cardiac catheterization. Invest Radiol 43(10):719–728PubMedCrossRefGoogle Scholar
  10. 10.
    LaBounty TM, Sundaram B, Agarwal P, Armstrong WA, Kazerooni EA, Yamada E (2008) Aortic valve area on 64-MDCT correlates with transesophageal echocardiography in aortic stenosis. AJR Am J Roentgenol 191(6):1652–1658PubMedCrossRefGoogle Scholar
  11. 11.
    Lembcke A, Kivelitz DE, Borges AC, Lachnitt A, Hein PA, Dohmen PM et al (2009) Quantification of aortic valve stenosis: head-to-head comparison of 64-slice spiral computed tomography with transesophageal and transthoracic echocardiography and cardiac catheterization. Invest Radiol 44(1):7–14PubMedCrossRefGoogle Scholar
  12. 12.
    Halpern EJ, Mallya R, Sewell M, Shulman M, Zwas DR (2009) Differences in aortic valve area measured with CT planimetry and echocardiography (continuity equation) are related to divergent estimates of left ventricular outflow tract area. AJR Am J Roentgenol 192(6):1668–1673PubMedCrossRefGoogle Scholar
  13. 13.
    Westermann Y, Geigenmuller A, Elgeti T, Wagner M, Dushe S, Borges AC et al (2011) Planimetry of the aortic valve orifice area: comparison of multislice spiral computed tomography and magnetic resonance imaging. Eur J Radiol 77(3):426–435PubMedCrossRefGoogle Scholar
  14. 14.
    Mizia-Stec K, Pysz P, Jasinski M, Adamczyk T, Drzewiecka-Gerber A, Chmiel A et al (2012) Preoperative quantification of aortic valve stenosis: comparison of 64-slice computed tomography with transesophageal and transthoracic echocardiography and size of implanted prosthesis. Int J Cardiovasc Imaging 28(2):343–352PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Bouvier E, Logeart D, Sablayrolles JL, Feignoux J, Scheuble C, Touche T et al (2006) Diagnosis of aortic valvular stenosis by multislice cardiac computed tomography. Eur Heart J 27(24):3033–3038PubMedCrossRefGoogle Scholar
  16. 16.
    Lembcke A, Woinke M, Borges AC, Dohmen PM, Lachnitt A, Westermann Y et al (2009) Grading of aortic valve stenosis at 64-slice spiral computed tomography: comparison with transthoracic echocardiography and calibration against cardiac catheterization. Invest Radiol 44(6):360–368PubMedCrossRefGoogle Scholar
  17. 17.
    Utsunomiya H, Yamamoto H, Horiguchi J, Kunita E, Okada T, Yamazato R et al (2012) Underestimation of aortic valve area in calcified aortic valve disease: effects of left ventricular outflow tract ellipticity. Int J Cardiol 157(3):347–353PubMedCrossRefGoogle Scholar
  18. 18.
    Fuchs A, Kuhl JT, Lonborg J, Engstrom T, Vejlstrup N, Kober L et al (2012) Automated assessment of heart chamber volumes and function in patients with previous myocardial infarction using multidetector computed tomography. J Cardiovasc Comput Tomogr 6(5):325–334PubMedCrossRefGoogle Scholar
  19. 19.
    Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al (2009) Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 22(1):1–23PubMedCrossRefGoogle Scholar
  20. 20.
    Doddamani S, Grushko MJ, Makaryus AN, Jain VR, Bello R, Friedman MA et al (2009) Demonstration of left ventricular outflow tract eccentricity by 64-slice multi-detector CT. Int J Cardiovasc Imaging 25(2):175–181PubMedCrossRefGoogle Scholar
  21. 21.
    Small GR, Kazmi M, Dekemp RA, Chow BJ (2011) Established and emerging dose reduction methods in cardiac computed tomography. J Nucl Cardiol 18(4):570–579PubMedCrossRefGoogle Scholar
  22. 22.
    Leipsic J, Labounty TM, Heilbron B, Min JK, Mancini GB, Lin FY et al (2010) Adaptive statistical iterative reconstruction: assessment of image noise and image quality in coronary CT angiography. AJR Am J Roentgenol 195(3):649–654PubMedCrossRefGoogle Scholar
  23. 23.
    Abdulla J, Sivertsen J, Kofoed KF, Alkadhi H, LaBounty T, Abildstrom SZ et al (2009) Evaluation of aortic valve stenosis by cardiac multislice computed tomography compared with echocardiography: a systematic review and meta-analysis. J Heart Valve Dis 18(6):634–643PubMedGoogle Scholar
  24. 24.
    Shah RG, Novaro GM, Blandon RJ, Whiteman MS, Asher CR, Kirsch J (2009) Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography. Int J Cardiovasc Imaging 25(6):601–609PubMedCrossRefGoogle Scholar
  25. 25.
    Messika-Zeitoun D, Aubry MC, Detaint D, Bielak LF, Peyser PA, Sheedy PF et al (2004) Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography. Circulation 110(3):356–362PubMedCrossRefGoogle Scholar
  26. 26.
    Koos R, Mahnken AH, Sinha AM, Wildberger JE, Hoffmann R, Kuhl HP (2004) Aortic valve calcification as a marker for aortic stenosis severity: assessment on 16-MDCT. AJR Am J Roentgenol 183(6):1813–1818PubMedCrossRefGoogle Scholar
  27. 27.
    Cowell SJ, Newby DE, Burton J, White A, Northridge DB, Boon NA et al (2003) Aortic valve calcification on computed tomography predicts the severity of aortic stenosis. Clin Radiol 58(9):712–716PubMedCrossRefGoogle Scholar
  28. 28.
    Baumgartner H (2006) Hemodynamic assessment of aortic stenosis: are there still lessons to learn? J Am Coll Cardiol 47(1):138–140PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Linnea Hornbech Larsen
    • 1
    Email author
  • Klaus Fuglsang Kofoed
    • 1
    • 2
  • Helle Gervig Carstensen
    • 3
  • Mads Rams Mejdahl
    • 1
  • Mads Jønsson Andersen
    • 1
  • Jesper Kjaergaard
    • 1
  • Olav Wendelboe Nielsen
    • 4
  • Lars Køber
    • 1
  • Rasmus Møgelvang
    • 1
  • Christian Hassager
    • 1
  1. 1.Department of CardiologyRigshospitalet, University of CopenhagenCopenhagenDenmark
  2. 2.Department of Radiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Cardiology, Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark
  4. 4.Department of Cardiology, Bispebjerg HospitalUniversity of CopenhagenCopenhagenDenmark

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