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

Joanna Bartkowiak; Chrisoula Dernektsi; Vratika Agarwal; Mark A Lebehn; Treena A Williams; Russel A Brandwein; Nicolas Brugger; Christoph Gräni; Stephan Windecker; Torsten P Vahl; Tamim M Nazif; Isaac George; Susheel K Kodali; Fabien Praz; Rebecca T Hahn

doi:10.1016/j.jcmg.2024.05.011

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

JACC Cardiovasc Imaging. 2024 Oct;17(10):1168-1178. doi: 10.1016/j.jcmg.2024.05.011. Epub 2024 Jul 24.

Authors

Affiliations

¹ 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.
² Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
³ Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
⁴ Department of Medicine, The New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA. Electronic address: [email protected].

PMID: 39066744
DOI: 10.1016/j.jcmg.2024.05.011

Abstract

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 mm², limit of agreement: -92.2 mm² to 143.3 mm²; P < 0.001; mean bias pre/post CT: 28.3 mm², limit of agreement: -65.8 mm² to 122.4 mm²; 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 (r² = 0.481; P < 0.001 for TEE and r² = 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.

Keywords: computed tomography; echocardiography; left ventricular outflow tract obstruction; mitral valve replacement; neo–left ventricular outflow tract.

Publication types

Multicenter Study
Comparative Study

MeSH terms

Aged
Aged, 80 and over
Cardiac Catheterization* / adverse effects
Echocardiography, Three-Dimensional*
Echocardiography, Transesophageal*
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valve Prosthesis Implantation* / instrumentation
Hemodynamics
Humans
Image Interpretation, Computer-Assisted
Male
Middle Aged
Mitral Valve Insufficiency / diagnostic imaging
Mitral Valve Insufficiency / physiopathology
Mitral Valve Insufficiency / surgery
Mitral Valve* / diagnostic imaging
Mitral Valve* / physiopathology
Mitral Valve* / surgery
Predictive Value of Tests*
Reproducibility of Results
Retrospective Studies
Treatment Outcome
Ventricular Function, Left*