Aortic stenosis: comparative evaluation of 16-detector row CT and echocardiography.
OBJECTIVE
To prospectively evaluate whether planimetric measurements of aortic valve area (AVA) with 16-detector row computed tomography (CT) allow classification of aortic stenosis (AS).


METHODS
The study had institutional review board approval; patients gave informed consent. Twenty patients (11 men, nine women; mean age, 63 years) with AS and 20 patients (10 men, 10 women; mean age, 65 years) without underwent transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and retrospectively electrocardiographically gated 16-detector row CT. Twenty CT data sets were reconstructed in 5% steps of R-R interval; data analysis was performed with four-dimensional software. Maximum AVA in systole planimetrically measured with CT (AVA(CT)) was compared with AVA planimetrically measured with TEE (AVA(TEE)), AVA calculated with the continuity equation and TTE (AVA(TTE)), and transvalvular pressure gradients determined with the Bernoulli equation and TTE. Correlations among AVA(CT), AVA(TTE), AVA(TEE), and transvalvular pressure gradients were tested with bivariate regression analysis; agreement between methods was assessed with the Bland-Altman method.


RESULTS
In patients without AS, mean AVA(CT) was 3.56 cm2 +/- 0.66 and mean AVA(TEE) was 3.43 cm2 +/- 0.69. In patients with AS, mean AVA(CT) was 0.89 cm2 +/- 0.35; mean AVA(TEE), 0.86 cm2 +/- 0.35; and mean AVA(TTE), 0.83 cm2 +/- 0.33. Mean transvalvular pressure gradient was 51 mm Hg +/- 22. Significant correlations were present between AVA(CT) and AVA(TEE) (r = 0.99, P < .001), AVA(CT) and AVA(TTE) (r = 0.95, P < .001), and AVA(CT) and transvalvular pressure gradients (r = -0.74, P < .01). Mean differences were -0.08 cm2 (limits of agreement: -0.32, 0.16) for AVA(CT) versus AVA(TEE) and 0.06 cm2 (limits of agreement: -0.15, 0.26) for AVA(CT) versus AVA(TTE).


CONCLUSIONS
Planimetric measurements of AVA with retrospectively electrocardiographically gated 16-detector row CT allow classification of AS that is similar to that achieved with measurements by using echocardiographic methods.
Alkadhi
Hatem
H
Institute of Diagnostic Radiology, Division of Cardiovascular Anesthesia, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. hatem.alkadhi@usz.ch
Wildermuth
Simon
S
Plass
Andre
A
Bettex
Dominique
D
Baumert
Bernhard
B
Leschka
Sebastian
S
Desbiolles
Lotus M
LM
Marincek
Borut
B
Boehm
Thomas
T
D000368:Aged; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000145:classification* / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*