3-Dimensional Echocardiographic Prediction of Left Ventricular Outflow Tract Area Prior to Transcatheter Mitral Valve Replacement.

Autor:	Bartkowiak J; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA; Graduate School for Health Sciences, University of Bern, Bern, Switzerland., Dernektsi C; Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland., Agarwal V; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Lebehn MA; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Williams TA; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Brandwein RA; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Brugger N; Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland., Gräni C; Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland., Windecker S; Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland., Vahl TP; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Nazif TM; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., George I; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Kodali SK; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Praz F; Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland., Hahn RT; Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA. Electronic address: rth2@columbia.edu.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2024 Oct; Vol. 17 (10), pp. 1168-1178. Date of Electronic Publication: 2024 Jul 24.
DOI:	10.1016/j.jcmg.2024.05.011
Abstrakt:	Background: New postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo-left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR). Objectives: This study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT). Methods: A total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients. Results: There was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm ² , limit of agreement: -92.2 mm ² to 143.3 mm ² ; P < 0.001; mean bias pre/post CT: 28.3 mm ² , limit of agreement: -65.8 mm ² to 122.4 mm ² ; P = 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r ² = 0.481; P < 0.001 for TEE and r ² = 0.401; P < 0.001 for CT). Conclusions: TEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR. Competing Interests: Funding Support and Author Disclosures Dr Bartkowiak has received grants from Novartis Foundation. Dr Windecker has received grants to the institution without personal remuneration from Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Braun, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, CardioValve, Cordis Medical, Corflow Therapeutics, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Farapulse Inc, Fumedica, Guerbet, Idorsia, Inari Medical, InfraRedx, Janssen-Cilag, Johnson and Johnson, Medalliance, Medicure, Medtronic, Merck Sharp and Dohm, Miracor Medical, MonarQ, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pharming Tech, Pfizer, Polares, Regeneron, Sanofi-Aventis, Servier, Sinomed, Terumo, Vifor, and V-Wave; has served as advisory board member and/or member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Boston Scientific, Biotronik, Bristol Myers Squibb, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, and V-Wave with payments to the institution but no personal payments; and has been a member of a steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. Dr George has received consulting fees from Zimmer Biomet, Atricure, Neosurgery, Neptune Medical, Abbvie, Johnson and Johnson, Durvena, Boston Scientific, Edwards Lifesciences, Medtronic, Help-TheraX, 3ive, Encompass, Summus Medical, Abbott SJM, BCI, and Xeltis; has been on advisory boards for Edwards Surgical, Medtronic Surgical, Medtronic Structural Mitral and Tricuspid, Trisol Medical, Valcare Medical, Durvena, Abbvie, Johnson and Johnson, Foldax Medical, Zimmer Biomet, Neosurgery, Abbvie, Boston Scientific, Summus Medical, BCI Equity: Valcare Medical, Durvena, CardioMech, Vdyne, MitreMedical, MITRx, and BCI; and has received institutional funding to Columbia University from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve. Dr Kodali has received institutional grants from Edwards Lifesciences, Medtronic, and Abbott; has received consulting fees from Abbott, Admedus, and Meril Lifesciences; and has equity options from Biotrace Medical and Thubrikar Aortic Valve Inc. Dr Praz has been compensated for travel expenses from Edwards Lifescicences, Abbott Vascular, Medira, Polares Medical, and Siemens Healthineers. Dr Hahn has received speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, Medtronic, and Philips Healthcare; has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Edwards Lifesciences, Medtronic, and Novartis; and the is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored tricuspid valve trials for which she receives no direct industry compensation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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