Retrospectively ECG-gated helical vs. non-ECG-synchronized high-pitch CTA of the aortic root for TAVI planning

Barbora Horehledova; Casper Mihl; Ellen Boswijk; Genevieve A. J. C. Crombag; Estelle C. Nijssen; Patty J. Nelemans; Leo F. Veenstra; Joachim E. Wildberger; Marco Das

doi:10.1371/journal.pone.0232673

Retrospectively ECG-gated helical vs. non-ECG-synchronized high-pitch CTA of the aortic root for TAVI planning

Barbora Horehledova^*, Casper Mihl, Ellen Boswijk, Genevieve A. J. C. Crombag, Estelle C. Nijssen, Patty J. Nelemans, Leo F. Veenstra, Joachim E. Wildberger, Marco Das

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background

Multidetector computed tomography (MDCT) plays a key role in patient assessment prior to transcatheter aortic valve implantation (TAVI). However, to date no consensus has been established on what is the optimal pre-procedural imaging protocol. Variability in pre-TAVI acquisition protocols may lead to discrepancies in aortic annulus measurements and may potentially influence prosthesis size selection.

Purpose

The current study evaluates the magnitude of differences in aortic annulus measurements using max-systolic, end-diastolic, and non-ECG-synchronized imaging, as well as the impact of method on prosthesis size selection.

Material and methods

Fifty consecutive TAVI-candidates, who underwent retrospectively-ECG-gated CT angiography (CTA) of the aortic root, directly followed by non-ECG-synchronized high-pitch CT of the entire aorta, were retrospectively included. Aortic root dimensions were assessed at each 10% increment of the R-R interval (0-100%) and on the non-ECG-synchronized scan. Dimensional changes within the cardiac cycle were evaluated using a 1-way repeated ANOVA. Agreement in measurements between max-systole, end-diastole and non-ECG-synchronized scans was assessed with Bland-Altman analysis.

Results

Maximal dimensions of the aortic root structures and minimum annulus-coronary ostia distances were measured during systole. Max-systolic measurements were significantly and substantially larger than end-diastolic (p

Conclusions

The systematic differences between max-systolic, end-diastolic and non-ECG-synchronized measurements for relevant aortic annular dimensions are both statistically significant and clinically relevant. Imaging strategy impacts prosthesis size selection in nearly half the TAVI-candidates. End-diastolic and non-ECG-synchronized imaging does not provide optimal information for prosthesis size selection. Systolic image acquisition is necessary for assessment of maximal annular dimensions and minimum annulus-coronary ostia distances.

Original language	English
Article number	0232673
Number of pages	14
Journal	PLOS ONE
Volume	15
Issue number	5
DOIs	https://doi.org/10.1371/journal.pone.0232673
Publication status	Published - 12 May 2020

Keywords

MULTIDETECTOR COMPUTED-TOMOGRAPHY
EXPERT CONSENSUS DOCUMENT
VALVE IMPLANTATION
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
CONTRAST MATERIAL
ANNULUS
REPLACEMENT
ANGIOGRAPHY
RISK

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10.1371/journal.pone.0232673Licence: CC BY

Cite this

@article{784a13e564a145aabbb28d8e6e6614e4,

title = "Retrospectively ECG-gated helical vs. non-ECG-synchronized high-pitch CTA of the aortic root for TAVI planning",

abstract = "BackgroundMultidetector computed tomography (MDCT) plays a key role in patient assessment prior to transcatheter aortic valve implantation (TAVI). However, to date no consensus has been established on what is the optimal pre-procedural imaging protocol. Variability in pre-TAVI acquisition protocols may lead to discrepancies in aortic annulus measurements and may potentially influence prosthesis size selection.PurposeThe current study evaluates the magnitude of differences in aortic annulus measurements using max-systolic, end-diastolic, and non-ECG-synchronized imaging, as well as the impact of method on prosthesis size selection.Material and methodsFifty consecutive TAVI-candidates, who underwent retrospectively-ECG-gated CT angiography (CTA) of the aortic root, directly followed by non-ECG-synchronized high-pitch CT of the entire aorta, were retrospectively included. Aortic root dimensions were assessed at each 10% increment of the R-R interval (0-100%) and on the non-ECG-synchronized scan. Dimensional changes within the cardiac cycle were evaluated using a 1-way repeated ANOVA. Agreement in measurements between max-systole, end-diastole and non-ECG-synchronized scans was assessed with Bland-Altman analysis.ResultsMaximal dimensions of the aortic root structures and minimum annulus-coronary ostia distances were measured during systole. Max-systolic measurements were significantly and substantially larger than end-diastolic (pConclusionsThe systematic differences between max-systolic, end-diastolic and non-ECG-synchronized measurements for relevant aortic annular dimensions are both statistically significant and clinically relevant. Imaging strategy impacts prosthesis size selection in nearly half the TAVI-candidates. End-diastolic and non-ECG-synchronized imaging does not provide optimal information for prosthesis size selection. Systolic image acquisition is necessary for assessment of maximal annular dimensions and minimum annulus-coronary ostia distances.",

keywords = "MULTIDETECTOR COMPUTED-TOMOGRAPHY, EXPERT CONSENSUS DOCUMENT, VALVE IMPLANTATION, TRANSESOPHAGEAL ECHOCARDIOGRAPHY, CONTRAST MATERIAL, ANNULUS, REPLACEMENT, ANGIOGRAPHY, RISK",

author = "Barbora Horehledova and Casper Mihl and Ellen Boswijk and Crombag, {Genevieve A. J. C.} and Nijssen, {Estelle C.} and Nelemans, {Patty J.} and Veenstra, {Leo F.} and Wildberger, {Joachim E.} and Marco Das",

note = "Funding Information: The authors received no specific funding for this work. The authors of this manuscript declare relationships with the following companies in form of institutional funding: Agfa, Bayer, GE, Philips, Optimed, Siemens and personal fees from speaker{\textquoteright}s bureau outside the submitted work: Bayer [BH; CM]; Bayer, Siemens [JW]; Bayer, Siemens, Cook [MD]. The above stated relationships had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2020 Horehledova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2020",

month = may,

day = "12",

doi = "10.1371/journal.pone.0232673",

language = "English",

volume = "15",

journal = "PLOS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "5",

}

TY - JOUR

T1 - Retrospectively ECG-gated helical vs. non-ECG-synchronized high-pitch CTA of the aortic root for TAVI planning

AU - Horehledova, Barbora

AU - Mihl, Casper

AU - Boswijk, Ellen

AU - Crombag, Genevieve A. J. C.

AU - Nijssen, Estelle C.

AU - Nelemans, Patty J.

AU - Veenstra, Leo F.

AU - Wildberger, Joachim E.

AU - Das, Marco

N1 - Funding Information: The authors received no specific funding for this work. The authors of this manuscript declare relationships with the following companies in form of institutional funding: Agfa, Bayer, GE, Philips, Optimed, Siemens and personal fees from speaker’s bureau outside the submitted work: Bayer [BH; CM]; Bayer, Siemens [JW]; Bayer, Siemens, Cook [MD]. The above stated relationships had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2020 Horehledova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2020/5/12

Y1 - 2020/5/12

N2 - BackgroundMultidetector computed tomography (MDCT) plays a key role in patient assessment prior to transcatheter aortic valve implantation (TAVI). However, to date no consensus has been established on what is the optimal pre-procedural imaging protocol. Variability in pre-TAVI acquisition protocols may lead to discrepancies in aortic annulus measurements and may potentially influence prosthesis size selection.PurposeThe current study evaluates the magnitude of differences in aortic annulus measurements using max-systolic, end-diastolic, and non-ECG-synchronized imaging, as well as the impact of method on prosthesis size selection.Material and methodsFifty consecutive TAVI-candidates, who underwent retrospectively-ECG-gated CT angiography (CTA) of the aortic root, directly followed by non-ECG-synchronized high-pitch CT of the entire aorta, were retrospectively included. Aortic root dimensions were assessed at each 10% increment of the R-R interval (0-100%) and on the non-ECG-synchronized scan. Dimensional changes within the cardiac cycle were evaluated using a 1-way repeated ANOVA. Agreement in measurements between max-systole, end-diastole and non-ECG-synchronized scans was assessed with Bland-Altman analysis.ResultsMaximal dimensions of the aortic root structures and minimum annulus-coronary ostia distances were measured during systole. Max-systolic measurements were significantly and substantially larger than end-diastolic (pConclusionsThe systematic differences between max-systolic, end-diastolic and non-ECG-synchronized measurements for relevant aortic annular dimensions are both statistically significant and clinically relevant. Imaging strategy impacts prosthesis size selection in nearly half the TAVI-candidates. End-diastolic and non-ECG-synchronized imaging does not provide optimal information for prosthesis size selection. Systolic image acquisition is necessary for assessment of maximal annular dimensions and minimum annulus-coronary ostia distances.

AB - BackgroundMultidetector computed tomography (MDCT) plays a key role in patient assessment prior to transcatheter aortic valve implantation (TAVI). However, to date no consensus has been established on what is the optimal pre-procedural imaging protocol. Variability in pre-TAVI acquisition protocols may lead to discrepancies in aortic annulus measurements and may potentially influence prosthesis size selection.PurposeThe current study evaluates the magnitude of differences in aortic annulus measurements using max-systolic, end-diastolic, and non-ECG-synchronized imaging, as well as the impact of method on prosthesis size selection.Material and methodsFifty consecutive TAVI-candidates, who underwent retrospectively-ECG-gated CT angiography (CTA) of the aortic root, directly followed by non-ECG-synchronized high-pitch CT of the entire aorta, were retrospectively included. Aortic root dimensions were assessed at each 10% increment of the R-R interval (0-100%) and on the non-ECG-synchronized scan. Dimensional changes within the cardiac cycle were evaluated using a 1-way repeated ANOVA. Agreement in measurements between max-systole, end-diastole and non-ECG-synchronized scans was assessed with Bland-Altman analysis.ResultsMaximal dimensions of the aortic root structures and minimum annulus-coronary ostia distances were measured during systole. Max-systolic measurements were significantly and substantially larger than end-diastolic (pConclusionsThe systematic differences between max-systolic, end-diastolic and non-ECG-synchronized measurements for relevant aortic annular dimensions are both statistically significant and clinically relevant. Imaging strategy impacts prosthesis size selection in nearly half the TAVI-candidates. End-diastolic and non-ECG-synchronized imaging does not provide optimal information for prosthesis size selection. Systolic image acquisition is necessary for assessment of maximal annular dimensions and minimum annulus-coronary ostia distances.

KW - MULTIDETECTOR COMPUTED-TOMOGRAPHY

KW - EXPERT CONSENSUS DOCUMENT

KW - VALVE IMPLANTATION

KW - TRANSESOPHAGEAL ECHOCARDIOGRAPHY

KW - CONTRAST MATERIAL

KW - ANNULUS

KW - REPLACEMENT

KW - ANGIOGRAPHY

KW - RISK

U2 - 10.1371/journal.pone.0232673

DO - 10.1371/journal.pone.0232673

M3 - Article

C2 - 32396570

SN - 1932-6203

VL - 15

JO - PLOS ONE

JF - PLOS ONE

IS - 5

M1 - 0232673

ER -