title: Automated 3-dimensional aortic annular assessment by multidetector computed tomography in transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study sought to evaluate the accuracy, reproducibility, and predictive value for post-procedural aortic regurgitation (AR) of an automated multidetector computed tomography (MDCT) post-processing imaging software, 3mensio Valves (version 5.1.sp1, 3mensio Medical Imaging BV, the Netherlands), in the assessment of patients undergoing transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Accurate pre-operative aortic annulus measurements are crucial for patients undergoing TAVI.
  
  
  METHODS
  One hundred five patients undergoing MDCT screening before TAVI were evaluated. Aortic annular measurement was compared between automated 3mensio Valves software and manual data post-processing software on a dedicated workstation; we analyzed the discrimination value of annulus measurement for post-procedural AR in 44 recipients of a self-expanding valve.
  
  
  RESULTS
  The automated 3mensio Valves software showed good concordance with manual MDCT measurements as demonstrated by Bland-Altman analysis. The automated software provided equally good reproducibility as manual measurement, especially for measurement of aortic annulus area (intraobserver intraclass correlation coefficients 0.98 vs. 0.97, interobserver 0.98 vs. 0.95). In 44 patients after implantation of a self-expanding valve, the valve diameter/CT-measured geometric mean annulus diameter ratio by automated 3mensio Valves software showed moderate and better discrimination ability in predicting post-procedural AR compared with manual measurement (p = 0.12, area under the curve 0.77, 95% confidence interval: 0.63 to 0.91, area under the curve 0.68, 95% confidence interval: 0.50 to 0.86, respectively).
  
  
  CONCLUSIONS
  The automated 3mensio Valves software demonstrated reliable, reproducible aortic annulus measurement and better predictive value for post-procedural AR, suggesting important clinical implications for pre-operative assessment of patients undergoing TAVI.
authors: Institut Cardiovasculaire Paris, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors: Yusuke
authors: Y
authors: Watanabe
authors: Marie-Claude
authors: MC
authors: Morice
authors: Erik
authors: E
authors: Bouvier
authors: Tora
authors: T
authors: Leong
authors: Kentaro
authors: K
authors: Hayashida
authors: Thierry
authors: T
authors: Lefèvre
authors: Thomas
authors: T
authors: Hovasse
authors: Mauro
authors: M
authors: Romano
authors: Bernard
authors: B
authors: Chevalier
authors: Patrick
authors: P
authors: Donzeau-Gouge
authors: Arnaud
authors: A
authors: Farge
authors: Bertrand
authors: B
authors: Cormier
authors: Philippe
authors: P
authors: Garot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D019540:Area Under Curve; D057205:Automation, Laboratory; D006328:Cardiac Catheterization / Q000295:instrumentation; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012984:Software
keywords: AR; AS; AUC; CI; ICC; MDCT; ROC; TAVI; TEE; annulus measurement; aortic regurgitation; aortic stenosis; area under the curve; confidence interval; geometric mean annulus diameter measured by computed tomography; intraclass correlation coefficient; lDiam-CT; long-axis annulus diameter measured by computed tomography; mDiam-CT; multidetector computed tomography; receiver-operating characteristic; sDiam-CT; short-axis annulus diameter measured by computed tomography; transcatheter aortic valve implantation; transesophageal echocardiography