title: Feasibility and accuracy of three-dimensional transthoracic echocardiography vs. multidetector computed tomography in the evaluation of aortic valve annulus in patient candidates to transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Proper measurement of the aortic annulus (AoA) is crucial for the success of transcatheter aortic valve implantation (TAVI). Transthoracic echocardiography (TTE) is the first step to assess AoA diameter, but a two-dimensional TTE (2DTTE) measurement is no longer accepted as the sole determinant of prosthetic size. The aims of the study were to evaluate feasibility and accuracy of three-dimensional TTE (3DTTE) estimation of AoA dimensions in comparison with multidetector computer tomography (MDCT).
  
  
  RESULTS
  We enrolled 100 consecutive patients referred for TAVI. Feasibility of AoA evaluation was 91% for 3DTTE and in 90% for MDCT. In 81 of 100 patients, AoA maximum diameter (max-D), minimum diameter (min-D), and area were measured and compared using 2DTTE, 3DTTE, and MDCT. Image quality of 3DTTE was sufficient in 47, good in 46 and optimal in 7%. High correlations (P < 0.001) were found between MDCT and 3DTTE (max-D: r = 0.89; min-D r = 0.86; area: r = 0.93), and between MDCT and 2DTTE (min-D: r = 0.81; area 0.78). The 3DTTE measurements were found to be highly reproducible on intra- and interobserver variability analyses. Regarding the choice of prosthesis size, agreement between 3DTTE and MDCT was very good (k = 0.84, P < 0.001) while it was poor between 2DTTE and MDCT (k = 0.36, P < 0.001).
  
  
  CONCLUSIONS
  3DTTE may be a valid imaging alternative in patients unsuitable for MDCT during the preoperative evaluation for TAVI. Evaluation of AoA through 3DTTE is feasible, and measurements closely approximate those of MDCT thus improving TTE accuracy in identifying the correct prosthesis size.
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy gloria.tamborini@ccfm.it.
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Fusini
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cefalù
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gripari
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Sarah Ghulam
authors.initials: SG
authors.lastname: Ali
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000601:surgery; D004452:Echocardiography / Q000379:methods; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods
keywords: Aortic valve stenosis; Multidetector computer tomography; Three-dimensional transthoracic echocardiography; Transcatheter aortic valve implantation