title: Measurement of the aortic annulus diameter using transesophageal echocardiography and multislice computed tomography--are they truly comparable?
abstract: BACKGROUND
  For transcatheter aortic valve implantation (TAVI), transesophageal echocardiography (TEE) and multislice computed tomography (MSCT) measurements of the aortic annulus diameter (AAD) are often regarded as competitive. We evaluated if 1 MSCT method could be interchangeable with TEE measurements.
  
  
  METHODS
  We compared AAD measurements performed using TEE, MSCT, and transthoracic echocardiography (TTE) in 129 consecutive patients with severe aortic stenosis (AS) who were referred for TAVI. Using MSCT, AAD was measured in the 3-chamber (3C) view and at the level of the virtual basal ring (mean diameter [MD] of the long-axis [LA] and short-axis [SA] diameters, and AAD derived from the cross-sectional area [CSA] and the circumference). Correlations with echocardiographic measurements and agreement regarding the TAVI strategy (decision to implant and choice of prosthesis size based on manufacturer cutoff recommendations) were assessed.
  
  
  RESULTS
  AAD measured in 3C (intraclass correlation [ICC], 0.79) and MD emphasizing the weight of the SA (MD4 [3 SA + LA/4]; ICC, 0.76) and MD5 [4 SA + LA/5; ICC, 0.75]) provided the highest correlation and the best agreement with TEE (kappa = 0.47, 0.27, and 0.31 respectively). However, TTE provided a better a correlation and agreement with TEE than all MSCT methods (ICC, 0.87; kappa = 0.66). The agreement between MSCT and TEE varied with AAD eccentricity and degree of aortic valve calcification (AVC), but in all subsets, values observed with MSCT never reached those observed with TTE.
  
  
  CONCLUSIONS
  MSCT and TEE are measuring different landmarks and consequently MSCT and TEE measurements are not interchangeable. Prospective randomized studies aimed at defining which method provides the best clinical results are clearly needed.
authors.affiliation: Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1148, Paris, France; University Paris 7, Bichat Hospital, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Serfaty
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.affiliation: Department of Biostatistics, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Esposito-Farese
authors.affiliation: Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pasi
authors.affiliation: Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Vania
authors.initials: V
authors.lastname: Tacher
authors.affiliation: Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
authors.affiliation: Department of Biostatistics, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1148, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1148, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1148, Paris, France; University Paris 7, Bichat Hospital, Paris, France. Electronic address: david.messika-zeitoun@bch.aphp.fr.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
mesh_terms: D000369:Aged, 80 and over; D001011:Aorta / Q000033:anatomy & histology*; D001021:Aortic Valve / Q000601:surgery; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D006801:Humans; D061330:Multidetector Computed Tomography