(1) Background: Hemodynamic assessment of prosthetic heart valves using conventional
2D transthoracic Echocardiography-Doppler (2D-TTE) has limitations. Of those, left ventricular
outflow tract (LVOT) area measurement is one of the major limitations of the continuity equation,
which assumes a circular LVOT. (2) Methods: This study comprised 258 patients with severe aortic
stenosis (AS), who were treated with the ACURATE neo2. The LVOT area and its dependent Dopplerderived
parameters, including effective orifice area (EOA) and stroke volume (SV), in addition
to their indexed values, were calculated from post-TAVI 2D-TTE. In addition, the 3D-LVOT area
from pre-procedural MDCT scans was obtained and used to calculate corrected Doppler-derived
parameters. The incidence rates of prosthesis patient mismatch (PPM) were compared between the
2D-TTE and MDCT-based methods (3) Results: The main results show that the 2D-TTE measured
LVOT is significantly smaller than 3D-MDCT (350.4 62.04 mm2 vs. 405.22 81.32 mm2) (95%
Credible interval (CrI) of differences: 55.15, 36.09), which resulted in smaller EOA (2.25 0.59 vs.
2.58 0.63 cm2) (Beta = 0.642 (95%CrI of differences: 0.85, 0.43), and lower SV (73.88 21.41 vs.
84.47 22.66 mL), (Beta = 7.29 (95% CrI: 14.45, 0.14)), respectively. PPM incidence appears more
frequent with 2D-TTE- than 3D-MDCT-corrected measurements (based on the EOAi) 8.52% vs. 2.32%,
respectively. In addition, significant differences regarding the EOA among the three valve sizes (S, M
and L) were seen only with the MDCT, but not on 2D-TTE. (4) Conclusions: The corrected continuity
equation by combining the 3D-LVOT area from MDCT with the TTE Doppler parameters might
provide a more accurate assessment of hemodynamic parameters and PPM diagnosis in patients
treated with TAVI. The ACURATE neo2 THV has a large EOA and low incidence of PPM using the
3D-corrected LVOT area than on 2D-TTE. These findings need further confirmation on long-term
follow-up and in other studies.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:91591 |
| Date | 23 May 2024 |
| Creators | Elkoumy, Ahmed, Rück, Andreas, Kim, Won-Keun, Abdel-Wahab, Mohamed, Abdelshafy, Mahmoud, De Backer, Ole, Elzomor, Hesham, Hengstenberg, Christian, Mohamed, Sameh K., Saleh, Nawzad, Arsang-Jang, Shahram, Bjursten, Henrik, Simpkin, Andrew, Meduri, Christopher U., Soliman, Osama |
| Publisher | MDPI |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 6103 |
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