title: Assessment of the aortic annulus by multislice computed tomography, contrast aortography, and trans-thoracic echocardiography in patients referred for transcatheter aortic valve implantation.
abstract: OBJECTIVE
  We sought to determine the level of agreement and the reproducibility of trans-thoracic echocardiography (TTE), contrast aortography (CA) and multislice computed tomography (MSCT) for the assessment of the aortic annulus, in patients referred for Transcatheter Aortic Valve Implantation (TAVI).
  
  
  BACKGROUND
  Correct measurement of the aortic annulus is important for TAVI.
  
  
  METHODS
  The dimensions of the aortic annulus were measured using TTE, CA and MSCT in 70 patients with severe aortic stenosis, referred for TAVI. Agreement between imaging techniques and interobserver variability was assessed using the Bland - Altman method and a linear regression model.
  
  
  RESULTS
  The MSCT Coronal view provided the largest mean annulus diameter (26.3 mm) followed by CA (24.4 mm), MSCT Mean (23.7 mm), TTE (22.6 mm), and MSCT Sagittal (21.8 mm) view. Differences in the annulus measurements were significant: MSCT Coronal view versus CA (mean, 95% confidence interval, Pearson's correlation) 2.0 mm, -1.9 to 6.0 mm, r = 0.72, CA versus MSCT Mean 0.2 mm, -3.3 to 3.7 mm, r = 0.76, MSCT Mean versus TTE 1.3 mm, -2.9 to 5.5 mm, r = 0.61, TTE versus MSCT Sagittal view 0.9 mm, -3.6 to 5.4 mm, r = 0.59, CA versus TTE 1.5 mm, -3.0 to 5.9 mm, r = 0.57. Interobserver variability was: TTE (mean, 95% confidence interval, Pearson's correlation) 0.29 mm, -4.2 to 4.8 mm, r = 0.57, CA 0.14 mm, -3.5 to 3.8 mm, r = 0.77, MSCT Mean 0.20 mm, -1.4 to 1.8 mm, r = 0.95.
  
  
  CONCLUSIONS
  We found significant differences in the dimensions of the aortic annulus measured by MSCT, CA, and TTE. Interobserver variability for TTE and CA was substantially higher compared with MSCT.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Schultz
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Adrian
authors.initials: A
authors.lastname: Moelker
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Rutger-Jan
authors.initials: RJ
authors.lastname: Nuis
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Peter P T
authors.initials: PP
authors.lastname: de Jaegere
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000628:therapy*; D001027:Aortography / Q000379:methods*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016014:Linear Models; D008297:Male; D009426:Netherlands; D015588:Observer Variation; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media