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Comprehensive Evaluation of Preoperative Patients with Aortic Valve Stenosis. Usefulness of Multi-Detector Cardiac Computed Tomography
  1. Jean-Pierre Laissy (jean-pierre.laissy{at}bch.aphp.fr)
  1. AP-HP, Bichat Hospital, France
    1. David Messika-Zeitoun (david.messika-zeitoun{at}bch.aphp.fr)
    1. AP-HP, Bichat Hospital, France
      1. Jean-Michel Serfaty
      1. AP-HP, Bichat Hospital, France
        1. Vincent Sebban
        1. AP-HP, Bichat Hospital, France
          1. Elisabeth Schouman-Claeys
          1. AP-HP, Bichat Hospital, France
            1. Bernard Iung
            1. AP-HP, Bichat Hospital, France
              1. Alec Vahanian
              1. AP-HP, Bichat Hospital, France

                Abstract

                Aims Preoperative assessment of patients with aortic valve stenosis (AS) relies on the evaluation of AS severity (aortic valve area or AVA) and left ventricular ejection fraction (LVEF) by echocardiography, and of coronary artery anatomy by coronary angiography. We sought to evaluate the feasibility and accuracy of contrast-enhanced Multi-Detector row Computed Tomography (MDCT), as a single non-invasive preoperative test, for simultaneous evaluation of the AVA, LVEF and coronary status in patients with AS.

                Methods Forty consecutive patients with AS scheduled for aortic valve replacement underwent within one week a transthoracic echocardiography, a ECG-gated MDCT and a coronary angiography.

                Results MDCT measurements could be performed in all patients. A good correlation but a slight overestimation was observed between AVA measured by MDCT and by echocardiography (0.87±0.22 vs. 0.81±0.20 cm2, p=0.01; r=0.75, p<0.0001). Mean difference between methods was 0.06±0.15 cm2. LVEF measured by MDCT correlated well with and did not differ from echocardiographic measurements (59±13 vs. 61±10%, p=0.34; r=0.76, p<0.0001; mean difference 1±8%). Coronary angiography displayed 33 lesions in 13 patients. MDCT correctly identified 26 of these 33 lesions and overestimated 3 less than 50% stenosis. On a segment-by segment analysis, MDCT sensitivity, specificity, positive and negative predictive values were 79 %, 99 %, 90 % and 98 % respectively. Per patient, MDCT had a sensitivity of 85 % (11/13 patients), a specificity of 93 % (25/27 patients), and positive and negative predictive values of 85 % (11/13 patients) and 93 % (25/27 patients), respectively.

                Conclusion MDCT can provide a simultaneous and accurate evaluation of the AVA, LVEF and coronary artery anatomy in patients with AS. In the near future, with technologic improvements, MDCT could achieve an exhaustive and comprehensive preoperative assessment of patients with AS. In addition, for the assessment of AS severity in difficult cases, MDCT could be considered as an alternative to transoesophageal echocardiography or cardiac catheterization.

                • aortic stenosis
                • coronary artery disease
                • multidetector row computed tomography

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