open access

Vol 76, No 12 (2018)
Original articles
Published online: 2018-09-12
Submitted: 2018-06-16
Accepted: 2018-09-11
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Predictors of aortic stenosis severity reclassification using an imaging data fusion method in patients referred for transcatheter aortic valve implantation

Patrycjusz Stokłosa, Ilona Michałowska, Piotr Duchnowski, Małgorzata Ryś, Agnieszka Żebrowska, Ewa Orłowska-Baranowska, Tomasz Hryniewiecki, Piotr Szymański
DOI: 10.5603/KP.a2018.0195
·
Pubmed: 30211435
·
Kardiol Pol 2018;76(12):1725-1732.

open access

Vol 76, No 12 (2018)
Original articles
Published online: 2018-09-12
Submitted: 2018-06-16
Accepted: 2018-09-11

Abstract

Background: The use of imaging data fusion method (IDFM) with multislice computed tomography (MSCT) and two-dimensional transthoracic echocardiography (2D-TTE) in patients with aortic stenosis (AS) may result in reclassification of AS severity from severe to non-severe.

Aim: We sought to establish potential predictors of AS severity reclassification using the IDFM method.

Methods: A total of 54 high-risk patients (mean age 79 ± 7.9 years; 40.7% male) with severe AS by 2D-TTE (indexed aortic valve area [AVAi] < 0.6 cm2/m2), referred for transcatheter aortic valve implantation, were included in the analysis. AVAi was subsequently recalculated using IDFM by replacing 2D-TTE left ventricular outflow tract (LVOT) measurements with MSCT LVOT parameters.

Results: Imaging data fusion method reclassified 20.4% patients into the potentially non-severe AS group. In a multivariable model including clinical variables, reclassification to non-severe AS by IDFM was independently associated with younger age and diabetes mellitus (DM), (odds ratio [OR] 0.864; 95% confidence interval [CI] 0.76–0.99; p < 0.035 and OR 19.259; 95% CI 2.28–162.41; p < 0.007, respectively). In a multivariable analysis of echocardiographic variables, reclassification was associ­ated with higher LVOT velocity time integral and lower aortic mean gradient (OR 1.402; 95% CI 1.07–1.84; p < 0.014 and OR 0.858; 95%: CI 0.760–0.968; p < 0.013, respectively). In addition, 24.1% of patients were reallocated from low-flow (< 35 mL/m2) to normal-flow AS.

Conclusions: Imaging data fusion method reclassified a substantial proportion of patients with severe AS into a potentially moderate AS group and from a low-flow to a normal-flow AS group. Such regrouping calls for increased diagnostic prudence in AS patients, especially those with specific clinical and echocardiographic predictors of reclassification, such as DM or low aortic mean gradient.

Abstract

Background: The use of imaging data fusion method (IDFM) with multislice computed tomography (MSCT) and two-dimensional transthoracic echocardiography (2D-TTE) in patients with aortic stenosis (AS) may result in reclassification of AS severity from severe to non-severe.

Aim: We sought to establish potential predictors of AS severity reclassification using the IDFM method.

Methods: A total of 54 high-risk patients (mean age 79 ± 7.9 years; 40.7% male) with severe AS by 2D-TTE (indexed aortic valve area [AVAi] < 0.6 cm2/m2), referred for transcatheter aortic valve implantation, were included in the analysis. AVAi was subsequently recalculated using IDFM by replacing 2D-TTE left ventricular outflow tract (LVOT) measurements with MSCT LVOT parameters.

Results: Imaging data fusion method reclassified 20.4% patients into the potentially non-severe AS group. In a multivariable model including clinical variables, reclassification to non-severe AS by IDFM was independently associated with younger age and diabetes mellitus (DM), (odds ratio [OR] 0.864; 95% confidence interval [CI] 0.76–0.99; p < 0.035 and OR 19.259; 95% CI 2.28–162.41; p < 0.007, respectively). In a multivariable analysis of echocardiographic variables, reclassification was associ­ated with higher LVOT velocity time integral and lower aortic mean gradient (OR 1.402; 95% CI 1.07–1.84; p < 0.014 and OR 0.858; 95%: CI 0.760–0.968; p < 0.013, respectively). In addition, 24.1% of patients were reallocated from low-flow (< 35 mL/m2) to normal-flow AS.

Conclusions: Imaging data fusion method reclassified a substantial proportion of patients with severe AS into a potentially moderate AS group and from a low-flow to a normal-flow AS group. Such regrouping calls for increased diagnostic prudence in AS patients, especially those with specific clinical and echocardiographic predictors of reclassification, such as DM or low aortic mean gradient.

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Keywords

aortic valve stenosis, echocardiography, multimodality imaging, multislice computed tomography, reclassification, transcatheter aortic valve implantation

About this article
Title

Predictors of aortic stenosis severity reclassification using an imaging data fusion method in patients referred for transcatheter aortic valve implantation

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 12 (2018)

Pages

1725-1732

Published online

2018-09-12

DOI

10.5603/KP.a2018.0195

Pubmed

30211435

Bibliographic record

Kardiol Pol 2018;76(12):1725-1732.

Keywords

aortic valve stenosis
echocardiography
multimodality imaging
multislice computed tomography
reclassification
transcatheter aortic valve implantation

Authors

Patrycjusz Stokłosa
Ilona Michałowska
Piotr Duchnowski
Małgorzata Ryś
Agnieszka Żebrowska
Ewa Orłowska-Baranowska
Tomasz Hryniewiecki
Piotr Szymański

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