A fully automated software platform for structural mitral valve analysis



To evaluate a novel fully automated mitral valve analysis software platform for cardiac computer tomography angiography (CCTA)-based structural heart therapy procedure planning.


The study included 52 patients (25 women; mean age, 66.9 ± 12.4 years) who had undergone CCTA prior to transcatheter mitral valve replacement (TMVR) or surgical mitral valve intervention (replacement or repair). Therapeutically relevant mitral valve annulus parameters (projected area, circumference, trigone-to-trigone (T-T) distance, anterior-posterior (AP) diameter, and anterolateral-posteromedial (AL-PM) diameter) were measured. Results of the fully automated mitral valve analysis software platform with and without manual adjustments were compared with the reference standard of a user-driven measurement program (3mensio, Pie Medical Imaging). Measurements were compared between the fully automated software, both with and without manual adjustment, and the user-driven program using intraclass correlation coefficients (ICC). A secondary analysis included the time to obtain all measurements.


Fully automated measurements showed a good to excellent agreement (circumference, ICC = 0.70; projected area, ICC = 0.81; T-T distance, ICC = 0.64; AP, ICC = 0.62; and AL-PM diameter, ICC = 0.78) compared with the user-driven analysis. There was an excellent agreement between fully automated measurement with manual adjustments and user-driven analysis regarding circumference (ICC = 0.91), projected area (ICC = 0.93), T-T distance (ICC = 0.80), AP (ICC = 0.78), and AL-PM diameter (ICC = 0.79). The time required for mitral valve analysis was significantly lower using the fully automated software with manual adjustments compared with the standard assessment (134.4 ± 36.4 s vs. 304.3 ± 77.7 s) (p < 0.01).


The fully automated mitral valve analysis software, when combined with manual adjustments, demonstrated a strong correlation compared with the user-driven software while reducing the total time required for measurement.

Key Points

• The novel software platform allows for a fully automated analysis of mitral valve structures.

• An excellent agreement was found between the fully automated measurement with manual adjustments and the user-driven analysis.

• The software showed quicker measurement time compared with the standard analysis of the mitral valve.

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Coronary artery disease


Cardiac computed tomography angiography


Computed tomography


Left atrial


Left ventricular




Transcatheter mitral valve replacement




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Corresponding author

Correspondence to U. Joseph Schoepf.

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The scientific guarantor of this publication is Prof. U. Joseph Schoepf.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

U. J. Schoepf receives institutional research support from Astellas, Bayer, Bracco, HeartFlow, and Siemens and has received honoraria for consulting and speaking from Bayer, Elucid BioImaging, GE, Guerbet, HeartFlow, and Siemens. A. Varga-Szemes received speaker fees from Guerbet and Siemens. P. Sahbaee and C. Schwemmer are employees of Siemens. The other authors have no conflicts of interest to disclose. The concepts and information presented are based on research and are not commercially available.

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Steinbach, R., Schoepf, U.J., Griffith, L.P. et al. A fully automated software platform for structural mitral valve analysis. Eur Radiol 30, 6528–6536 (2020). https://doi.org/10.1007/s00330-020-06983-7

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  • Mitral valve
  • Transcatheter mitral valve replacement
  • Automated mitral valve analysis
  • Computed tomography