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Elkoumy, Ahmed [Author]; Rück, Andreas [Author]; Kim, Won-Keun [Author]; Abdel-Wahab, Mohamed [Author]; Abdelshafy, Mahmoud [Author]; De Backer, Ole [Author]; Elzomor, Hesham [Author]; Hengstenberg, Christian [Author]; Mohamed, Sameh K. [Author]; Saleh, Nawzad [Author]; Arsang-Jang, Shahram [Author]; Bjursten, Henrik [Author]; Simpkin, Andrew [Author]; Meduri, Christopher U. [Author]; Soliman, Osama [Author]

Core Lab Adjudication of the ACURATE neo2 Hemodynamic Performance Using Computed-Tomography-Corrected Left Ventricular Outflow Tract Area

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  • Media type: E-Article
  • Title: Core Lab Adjudication of the ACURATE neo2 Hemodynamic Performance Using Computed-Tomography-Corrected Left Ventricular Outflow Tract Area
  • Contributor: Elkoumy, Ahmed [Author]; Rück, Andreas [Author]; Kim, Won-Keun [Author]; Abdel-Wahab, Mohamed [Author]; Abdelshafy, Mahmoud [Author]; De Backer, Ole [Author]; Elzomor, Hesham [Author]; Hengstenberg, Christian [Author]; Mohamed, Sameh K. [Author]; Saleh, Nawzad [Author]; Arsang-Jang, Shahram [Author]; Bjursten, Henrik [Author]; Simpkin, Andrew [Author]; Meduri, Christopher U. [Author]; Soliman, Osama [Author]
  • Published: Basel: MDPI, [2024]
  • Published in: Journal of Clinical Medicine ; 11, (2022)
  • Language: English
  • Keywords: left ventricular outflow tract ; computed tomography ; hemodynamic performance ; aortic stenosis ; echocardiography ; prosthesis patient mismatch ; ACURATE neo2
  • Origination:
  • Footnote:
  • Description: (1) Background: Hemodynamic assessment of prosthetic heart valves using conventional2D transthoracic Echocardiography-Doppler (2D-TTE) has limitations. Of those, left ventricularoutflow 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 aorticstenosis (AS), who were treated with the ACURATE neo2. The LVOT area and its dependent Dopplerderivedparameters, including effective orifice area (EOA) and stroke volume (SV), in additionto their indexed values, were calculated from post-TAVI 2D-TTE. In addition, the 3D-LVOT areafrom pre-procedural MDCT scans was obtained and used to calculate corrected Doppler-derivedparameters. The incidence rates of prosthesis patient mismatch (PPM) were compared between the2D-TTE and MDCT-based methods (3) Results: The main results show that the 2D-TTE measuredLVOT is significantly smaller than 3D-MDCT (350.462.04 mm2 vs. 405.2281.32 mm2) (95%Credible interval (CrI) of differences: 55.15, 36.09), which resulted in smaller EOA (2.250.59 vs.2.580.63 cm2) (Beta = 0.642 (95%CrI of differences: 0.85, 0.43), and lower SV (73.8821.41 vs.84.4722.66 mL), (Beta = 7.29 (95% CrI: 14.45, 0.14)), respectively. PPM incidence appears morefrequent 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, Mand L) were seen only with the MDCT, but not on 2D-TTE. (4) Conclusions: The corrected continuityequation by combining the 3D-LVOT area from MDCT with the TTE Doppler parameters mightprovide a more accurate assessment of hemodynamic parameters and PPM diagnosis in patientstreated with TAVI. The ACURATE neo2 THV has a large EOA and low incidence of PPM using the3D-corrected LVOT area than on 2D-TTE. These findings need further confirmation on long-termfollow-up and in other studies.
  • Access State: Open Access
  • Rights information: Attribution (CC BY)