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76: Analysis of Mitral Annular Geometry by MDCT in Patients with Degenerative Mitral Valve Disease
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Journal of Cardiovascular Computed Tomography, Vol 2, No 4S, July/August 2008
criteria of LVH on computed tomographic angiography (CTA) can improve the detection of LVH on CT. Methods: 2238 subjects (63±9 years, 27% female) who underwent CTA (Electron Beam, GE-Imatron, Milwaukee, WI) were studied (1557 with CTA diagnosed CAD and 798 with normal coronari es). The electrocardiographic end-systolic triggered scans with 1.5-3mm slice thickness, with mAs 630-1000, kV 130-140, and 50-100 msec were performed. Left ventricular mass (LVM) measured manually using GE Advantage Workstation and TeraRecon Aquarius Workst ation. The new criteria of LVH was defined as LVM above 95 th percentile per gender and compared to previous echocardiographic criteria (110g/m² in women and 124g/ m² in men) and specificity and sensitivity of both models to detect LVH was calculated. Results: The LVM was more in men than women in normal cohorts (75.5 ± 14.0 g/m² vs. 63.1 ±12.8 g/m², p=0.001). Comparing the new CTA criteria of LVH (103.0 g/ m² in male and 89.0 g/ m² in female) to the previous echocardiographic criteria of LVH, the specificity in females and males decreased from 100 to 91.8%, 100 to 92.6% respectively but the sensitivity increased from 42.0 to 100%, and from 41.1 to 100%. The coefficient of variation of LVM m easurement was 3.8%. Conclusion: This study suggests that CTA measured LVM with low variability, can significantly increase the accuracy of early detection of left ventricular hypertrophy by computed tomography.
aortic root in patients with AS vs. elderly gender matched controls using multidetector computed tomography (MDCT). Methods: Twenty-five consecutive subjects with calcific AS who were referred for PAVR and 25 normal, elderly gender mat ched controls (56% male, 76±7 years) were scanned on a Siemens Definition Dual Source MDCT scanner after receiving iodinated contrast. Images were reconstructed during 10-14 phases of the cardiac cycle with temporal resolution = 83 ms and slice thickness = 0.75 mm. Results: Subjects with AS had reduced distance from the aortic valve annulus to the inferior margins of the left coronary artery ostium, right coronary artery ostium, and sinotubular junction, compared to controls (table). There was no significant difference in the transverse diameter of the aortic root at the level of the aortic annulus, sinuses of Valsalva, sinotubular junction, or left ventricular outflow tract between the two groups (table). Conclusions: Longitudinal remodeling of the aortic root occurs in calcific aortic stenosis, as manifested by reduced distances from the aortic valve annulus to the coronary artery ostia and sinotubular junction in patients with AS, compared to elderly gender matched controls. These findings have implications for the design and deployment of PAVR devices.
76 Babu B, Adams D, Cobo M, Prat-Gonzalez S, Sanz J, Garcia MJ. Analysis of Mitral Annular Geometry by MDCT in Patients with Degenerative Mitral Valve Disease Mount Sinai Medical School, New York, NY
Parameter
Introduction: Multidetector computed tomography (MDCT) provides superior 3-dimensional definition of the cardiac anatomy. A precise definition of the mitral annular geometry in-vivo may be useful to plan the complex repair of degenerative mitral valve disease (DMVD). Methods: Eleven consecutive patients (age 51+15 years, 4 male) with DMVD referred for pre-operative evaluation with MDCT prior to mitral valve repair were compared with 11 matched controls (age 57+12 years, 7 male). Contrast-enhanced ECG-gated studies were acquired in a 64-slice MDCT scanner (Siemens Sensation) with a 0.6mm slice thickness. Studies were reconstructed at multiple cardiac phases at 10% increments. End-diastolic and end-systolic images were analyzed in a cardiac workstation (TeraRecon). LV volumes we re determined by direct 3-dimensional volumetric analysis using a pixel-intensity algorithm. Left atrial areas (LAA) were planimetered from the 4chamber view. End-diastolic and end-systolic mitral annular areas (MAA) were determined by direct planimetry, and antero-posterior (AP) and septo-lateral (SL) diameters were measured from a 3-D guided reconstruction of the annular plane. Results: End-diastolic MAA were larger in DMVD patients (16+5cm2) than in controls (11+3cm2, p <0.01), despite similar end-diastolic LAA (21+6 vs. 20+6cm2, p = 0.77). DMVD patients had larger LV volumes (155+37 vs. 110+42ml, p =0.02). End-diastolic MAA was correlated with LV end-diastolic volume (r =0.53, p <0.05). Differences in SL diameters (53+9 vs. 44+5mm, p <0.01) were slightly larger than in AP diameters (36+7 vs. 30+7mm, p =0.05). MAA increased by 27+16% in DMVD and by 26+17% in controls. Conclusions: Mitral annular enlargement in DMVD patients appears to be related to LV end-diastolic volume. A signifi cant end-systolic increase in MAA occurs in both normal and DMVD patients, in parallel with the systolic increase in LA dimensions. These considerations may be important in future design of mitral annular support rings. 77 Akhtar M, Tuzcu EM, Kapadia S, Svensson L, Green berg R, Roselli E, Halliburton S, Kurra V, Schoenhagen P, S ola S. Longitudinal Remodeling of the Aortic Root in Patients with Calcific Aortic Stenosis: Implications for Percutaneous Aortic Valve Replacement Cleveland Clinic Foundation, Cleveland, OH Introduction: Percutaneous aortic valve replacement (PAVR) is an emerging therapy for selected patients with aortic stenosis (AS). Preoperative assessment of aortic root morphology facilitates deployment of the PAVR device. We compared morphologic charact eristics of the
Table: Aortic Root Morphology in Aortic Stenosis vs. Elderly Gender Matched Controls
Aortic valve annulus to right coronary artery ostium (mm) Aortic valve annulus to left coronary artery ostium (mm) Aortic valve annulus to sinotubular junction (mm) Aortic valve annulus diameter (mm) Sinuses of Valsalva diameter (mm) Sinotubular junction diameter (mm) Left ventricular outflow tract (mm)
Aortic Stenosis (n=25) 13.6 ± 2.8
Controls (n=25)
pvalue
15.2 ± 2.5
0.04
13.4 ± 3.2
15.6 ± 2.7
0.01
16.7 ± 2.0
21.0 ± 2.3
<0.01
27.2 ± 3.5
27.2 ± 4.0
0.99
34.7 ± 4.7
36.7 ± 5.3
0.17
27.1 ± 3.8
28.2 ± 4.7
0.40
24.6 ± 3.6
25.1 ± 3.0
0.65
78 Kurra V, Sola S, Svensson L, Tuzcu M, Kapadia S, Greenberg R, Roselli E, Halliburton S, Schoenhagen P. Presence of Significant PAD in Patients Assessed fo r Percutaneous Aortic Valve Replacement. Implications for Feasibility of the Transfemoral Approach The Cleveland Clinic, Cleveland, OH Introduction: Percutaneous aortic valve replacement (PAVR) is an emerging treatment option for selected patients with advanced aortic stenosis (AS) and may be done from a transfemoral or transapical approach. The prevalence of significant PAD/unsuitable iliofemoral anatomy in this high-risk population is unknown. We evaluated the utility of cardiac multi-detector computed tomography (MDCT) in identifying suitable candidates for a transfemoral approach to PAVR. Methods: We evaluated consecutive patients with calcific AS who were referred for PAVR. Patients with known periphe ral vascular disease were excluded. All patients were scanned on a Siemens Definition Dual Source MDCT scanner after receiving iodinated contrast dose of 120-150 ml. Images of the chest, abdomen, and pelvis to the level of the mid thigh were reconstructed at 3 mm slice thickness to evaluate the aorta and iliofemoral vessels. The common iliac, external iliac, and common femoral arteries were evaluated for minimal luminal diameter < 8 mm, severe calcification, presence of dense calcification at the iliac bifurcation, and angulation of the external iliac to the common and internal iliac arteries. Results: 85 patients (80±7 years, 58% male) were enrolled. The mean luminal diameter of the common iliac, external iliac, and common
Journal of Cardiovascular Computed Tomography, Vol 2, No 4S, July/August 2008
criteria of LVH on computed tomographic angiography (CTA) can improve the detection of LVH on CT. Methods: 2238 subjects (63±9 years, 27% female) who underwent CTA (Electron Beam, GE-Imatron, Milwaukee, WI) were studied (1557 with CTA diagnosed CAD and 798 with normal coronari es). The electrocardiographic end-systolic triggered scans with 1.5-3mm slice thickness, with mAs 630-1000, kV 130-140, and 50-100 msec were performed. Left ventricular mass (LVM) measured manually using GE Advantage Workstation and TeraRecon Aquarius Workst ation. The new criteria of LVH was defined as LVM above 95 th percentile per gender and compared to previous echocardiographic criteria (110g/m² in women and 124g/ m² in men) and specificity and sensitivity of both models to detect LVH was calculated. Results: The LVM was more in men than women in normal cohorts (75.5 ± 14.0 g/m² vs. 63.1 ±12.8 g/m², p=0.001). Comparing the new CTA criteria of LVH (103.0 g/ m² in male and 89.0 g/ m² in female) to the previous echocardiographic criteria of LVH, the specificity in females and males decreased from 100 to 91.8%, 100 to 92.6% respectively but the sensitivity increased from 42.0 to 100%, and from 41.1 to 100%. The coefficient of variation of LVM m easurement was 3.8%. Conclusion: This study suggests that CTA measured LVM with low variability, can significantly increase the accuracy of early detection of left ventricular hypertrophy by computed tomography.
aortic root in patients with AS vs. elderly gender matched controls using multidetector computed tomography (MDCT). Methods: Twenty-five consecutive subjects with calcific AS who were referred for PAVR and 25 normal, elderly gender mat ched controls (56% male, 76±7 years) were scanned on a Siemens Definition Dual Source MDCT scanner after receiving iodinated contrast. Images were reconstructed during 10-14 phases of the cardiac cycle with temporal resolution = 83 ms and slice thickness = 0.75 mm. Results: Subjects with AS had reduced distance from the aortic valve annulus to the inferior margins of the left coronary artery ostium, right coronary artery ostium, and sinotubular junction, compared to controls (table). There was no significant difference in the transverse diameter of the aortic root at the level of the aortic annulus, sinuses of Valsalva, sinotubular junction, or left ventricular outflow tract between the two groups (table). Conclusions: Longitudinal remodeling of the aortic root occurs in calcific aortic stenosis, as manifested by reduced distances from the aortic valve annulus to the coronary artery ostia and sinotubular junction in patients with AS, compared to elderly gender matched controls. These findings have implications for the design and deployment of PAVR devices.
76 Babu B, Adams D, Cobo M, Prat-Gonzalez S, Sanz J, Garcia MJ. Analysis of Mitral Annular Geometry by MDCT in Patients with Degenerative Mitral Valve Disease Mount Sinai Medical School, New York, NY
Parameter
Introduction: Multidetector computed tomography (MDCT) provides superior 3-dimensional definition of the cardiac anatomy. A precise definition of the mitral annular geometry in-vivo may be useful to plan the complex repair of degenerative mitral valve disease (DMVD). Methods: Eleven consecutive patients (age 51+15 years, 4 male) with DMVD referred for pre-operative evaluation with MDCT prior to mitral valve repair were compared with 11 matched controls (age 57+12 years, 7 male). Contrast-enhanced ECG-gated studies were acquired in a 64-slice MDCT scanner (Siemens Sensation) with a 0.6mm slice thickness. Studies were reconstructed at multiple cardiac phases at 10% increments. End-diastolic and end-systolic images were analyzed in a cardiac workstation (TeraRecon). LV volumes we re determined by direct 3-dimensional volumetric analysis using a pixel-intensity algorithm. Left atrial areas (LAA) were planimetered from the 4chamber view. End-diastolic and end-systolic mitral annular areas (MAA) were determined by direct planimetry, and antero-posterior (AP) and septo-lateral (SL) diameters were measured from a 3-D guided reconstruction of the annular plane. Results: End-diastolic MAA were larger in DMVD patients (16+5cm2) than in controls (11+3cm2, p <0.01), despite similar end-diastolic LAA (21+6 vs. 20+6cm2, p = 0.77). DMVD patients had larger LV volumes (155+37 vs. 110+42ml, p =0.02). End-diastolic MAA was correlated with LV end-diastolic volume (r =0.53, p <0.05). Differences in SL diameters (53+9 vs. 44+5mm, p <0.01) were slightly larger than in AP diameters (36+7 vs. 30+7mm, p =0.05). MAA increased by 27+16% in DMVD and by 26+17% in controls. Conclusions: Mitral annular enlargement in DMVD patients appears to be related to LV end-diastolic volume. A signifi cant end-systolic increase in MAA occurs in both normal and DMVD patients, in parallel with the systolic increase in LA dimensions. These considerations may be important in future design of mitral annular support rings. 77 Akhtar M, Tuzcu EM, Kapadia S, Svensson L, Green berg R, Roselli E, Halliburton S, Kurra V, Schoenhagen P, S ola S. Longitudinal Remodeling of the Aortic Root in Patients with Calcific Aortic Stenosis: Implications for Percutaneous Aortic Valve Replacement Cleveland Clinic Foundation, Cleveland, OH Introduction: Percutaneous aortic valve replacement (PAVR) is an emerging therapy for selected patients with aortic stenosis (AS). Preoperative assessment of aortic root morphology facilitates deployment of the PAVR device. We compared morphologic charact eristics of the
Table: Aortic Root Morphology in Aortic Stenosis vs. Elderly Gender Matched Controls
Aortic valve annulus to right coronary artery ostium (mm) Aortic valve annulus to left coronary artery ostium (mm) Aortic valve annulus to sinotubular junction (mm) Aortic valve annulus diameter (mm) Sinuses of Valsalva diameter (mm) Sinotubular junction diameter (mm) Left ventricular outflow tract (mm)
Aortic Stenosis (n=25) 13.6 ± 2.8
Controls (n=25)
pvalue
15.2 ± 2.5
0.04
13.4 ± 3.2
15.6 ± 2.7
0.01
16.7 ± 2.0
21.0 ± 2.3
<0.01
27.2 ± 3.5
27.2 ± 4.0
0.99
34.7 ± 4.7
36.7 ± 5.3
0.17
27.1 ± 3.8
28.2 ± 4.7
0.40
24.6 ± 3.6
25.1 ± 3.0
0.65
78 Kurra V, Sola S, Svensson L, Tuzcu M, Kapadia S, Greenberg R, Roselli E, Halliburton S, Schoenhagen P. Presence of Significant PAD in Patients Assessed fo r Percutaneous Aortic Valve Replacement. Implications for Feasibility of the Transfemoral Approach The Cleveland Clinic, Cleveland, OH Introduction: Percutaneous aortic valve replacement (PAVR) is an emerging treatment option for selected patients with advanced aortic stenosis (AS) and may be done from a transfemoral or transapical approach. The prevalence of significant PAD/unsuitable iliofemoral anatomy in this high-risk population is unknown. We evaluated the utility of cardiac multi-detector computed tomography (MDCT) in identifying suitable candidates for a transfemoral approach to PAVR. Methods: We evaluated consecutive patients with calcific AS who were referred for PAVR. Patients with known periphe ral vascular disease were excluded. All patients were scanned on a Siemens Definition Dual Source MDCT scanner after receiving iodinated contrast dose of 120-150 ml. Images of the chest, abdomen, and pelvis to the level of the mid thigh were reconstructed at 3 mm slice thickness to evaluate the aorta and iliofemoral vessels. The common iliac, external iliac, and common femoral arteries were evaluated for minimal luminal diameter < 8 mm, severe calcification, presence of dense calcification at the iliac bifurcation, and angulation of the external iliac to the common and internal iliac arteries. Results: 85 patients (80±7 years, 58% male) were enrolled. The mean luminal diameter of the common iliac, external iliac, and common