title: Three-dimensional echocardiography vs. computed tomography for transcatheter aortic valve replacement sizing.
abstract: OBJECTIVE
  The accuracy of transcatheter aortic valve replacement (TAVR) sizing using three-dimensional transoesophageal echocardiography (3D-TEE) compared with the gold-standard multi-slice computed tomography (MSCT) remains unclear. We compare aortic annulus measurements assessed using these two imaging modalities.
  
  
  RESULTS
  We performed a single-centre prospective cohort study, including 53 consecutive patients undergoing TAVR, who had both MSCT and 3D-TEE for aortic annulus sizing. Aortic annular dimensions, expected transcatheter heart valve (THV) oversizing, and hypothetical valve size selection based on CT and TEE were compared. 3D-TEE and CT cross-sectional mean diameter (r = 0.69), perimeter (r = 0.70), and area (r = 0.67) were moderately to highly correlated (all P-values <0.0001). 3D-TEE-derived measurements were significantly smaller compared with MSCT: perimeter (68.6 ± 5.9 vs. 75.1 ± 5.7 mm, respectively; P < 0.0001); area (345.6 ± 64.5 vs. 426.9 ± 68.9 mm(2), respectively; P < 0.0001). The percentage difference between 3D-TEE and MSCT measurements was around 9%. Agreement between MSCT- and 3D-TEE-based THV sizing (perimeter) occurred in 44% of patients. Using the 3D-TEE perimeter annular measurements, up to 50% of patients would have received an inappropriate valve size according to manufacturer-recommended, area-derived sizing algorithms.
  
  
  CONCLUSIONS
  Aortic annulus measurements for pre-procedural TAVR assessment by 3D-TEE are significantly smaller than MSCT. In this study, such discrepancy would have resulted in up to 50% of all patients receiving the wrong THV size. 3D-TEE should be used for TAVR sizing, only when MSCT is not available or contraindicated. The clinical impact of this information requires further study.
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelone, Spain beavaquerizo@yahoo.es.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Vaquerizo
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Spaziano
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada.
authors.forename: Juwairia
authors.initials: J
authors.lastname: Alali
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada University Hospital Galway, Galway, Ireland.
authors.forename: Darren
authors.initials: D
authors.lastname: Mylote
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada.
authors.forename: Pascal
authors.initials: P
authors.lastname: Theriault-Lauzier
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada.
authors.forename: Rashed
authors.initials: R
authors.lastname: Alfagih
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martucci
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Buithieu
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H3A 3J1, Canada.
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001024:Aortic Valve Stenosis / Q000601:surgery*; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011446:Prospective Studies; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome
keywords: multi-slice computed tomography; three-dimensional (3D) transoesophageal echocardiography; transcatheter aortic valve replacement