Large-field intravascular ultrasound for annular sizing and predicting paravalvular regurgitation during TAVR: comparisons with multidetector computed tomography and transoesophageal echocardiography.
OBJECTIVE
The use of contrast media with multidetector computed tomography (MDCT) may induce acute kidney injury in patients with renal failure undergoing transcatheter aortic valve replacement (TAVR). We investigated the role of large-field intravascular ultrasound (IVUS) vs. MDCT and two-dimensional transoesophageal echocardiography (2D-TEE) for annular sizing and predicting paravalvular regurgitation (PVR) during TAVR.


RESULTS
The aortic annulus was measured by large-field IVUS and 2D-TEE, and compared with MDCT in 50 patients undergoing TAVR. The IVUS and MDCT annular areas and diameters were not significantly different (446 ± 87 mm2 and 23.8 ± 84 mm vs. 466 ± 84 mm2 and 24 ± 2.1 mm, respectively; P > 0.05). IVUS and MDCT mean annular diameters were significantly greater than TEE diameter (23.8 ± 2.4 and 24 ± 2.1 vs. 22 ± 0.65 mm, respectively; P < 0.01). PVR ≥ Mild occurred in 13 patients (26%); 5 patients required post-dilation and 2 patients a second valve. Receiver operating characteristic analyses showed that transcatheter heart valve (THV) area - IVUS or MDCT areas equally predicted of ≥ mild PVR (areas under the curve [AUC] 0.79 and 0.81, respectively; P < 0.001), and were greater than THV diameter-TEE diameter (AUC 0.79 and 0.81 vs. 0.56, respectively; P < 0.05).


CONCLUSIONS
The aortic annular measurements and predicting PVR by large field IVUS were not significantly different from those of MDCT, but were greater than those of TEE. Large filed IVUS can be reliably used in lieu of MDCT for annular sizing in patients with aortic stenosis and renal failure or suboptimal MDCT images.
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.|Suez Canal University, Ismailia, Egypt.
Diaa
D
Hakim
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.
Gopal
G
Ghimire
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.
Oluseun O
OO
Alli
Department of Radiology, University of Alabama-Birmingham.
Satinder
S
Singh
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.
Mark F
MF
Sasse
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.
Oscar J
OJ
Booker
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.
Garima
G
Arora
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.
Tara
T
Leesar
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.
Lindsey
L
Jernigan
Division of Cardiac and Thoracic Surgery, University of Alabama-Birmingham, 510 20th Street South Birmingham, AL 35294 USA.
Spencer J
SJ
Melby
Division of Cardiac and Thoracic Surgery, University of Alabama-Birmingham, 510 20th Street South Birmingham, AL 35294 USA.
James E
JE
Davies
Division of Cardiology, University of Alabama-Birmingham, 510 20th Street South, FOT:920, AL 35294, Birmingham.
Massoud A
MA
Leesar
D000704:Analysis of Variance; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D019540:Area Under Curve; D016009:Chi-Square Distribution; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
IVUS; MDCT; TAVR; TEE; aortic stenosis