Utility of Three-Dimensional Transesophageal Echocardiography for Mitral Annular Sizing in Transcatheter Mitral Valve Replacement Procedures: A Cardiac Computed Tomographic Comparative Study

• Published in: Journal of the American Society of Echocardiography Vol. 33; no. 10; pp. 1245 - 1252.e2
• Main Authors: Coisne, Augustin, Pontana, François, Aghezzaf, Samy, Mouton, Stéphanie, Ridon, Hélène, Richardson, Marjorie, Polge, Anne-Sophie, Longère, Benjamin, Silvestri, Valentina, Pagniez, Julien, Bical, Antoine, Rousse, Natacha, Overtchouk, Pavel, Granada, Juan F., Hahn, Rebecca T., Modine, Thomas, Montaigne, David
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2020; Elsevier
• Subjects: Cardiovascular; Heart team; Life Sciences; Mitral annulus; Multimodality imaging; Three-dimensional; Transcatheter mitral valve replacement; Mitral annulus; AF; MR; LV; LVOT; AUC; PM-AL; 3D; CT; TMVR; Multimodality imaging; Three-dimensional; MA; TEE; Heart team; Transcatheter mitral valve replacement; Left ventricular; Area under the curve; Left ventricular outflow tract; Transesophageal echocardiographic; Computed tomographic; Atrial fibrillation; Mitral annular; Posteromedial-anterolateral; Mitral regurgitation
• ISSN: 0894-7317; 1097-6795; 1097-6795
• DOI: 10.1016/j.echo.2020.04.030

Three-dimensional (3D) transesophageal echocardiographic (TEE) imaging is frequently used as an initial screening tool in the evaluation of patients who are candidates for transcatheter mitral valve replacement (TMVR). However, little is known about the imaging correlation with the gold standard, computed tomographic (CT) imaging. The aims of this study were to test the quantitative differences between these two modalities and to determine the best 3D TEE parameters for TMVR screening. Fifty-seven patients referred to the heart valve clinic for TMVR with prostheses specifically designed for the mitral valve were included. Mitral annular (MA) analyses were performed using commercially available software on 3D TEE and CT imaging. Three-dimensional TEE imaging was feasible in 52 patients (91%). Although 3D TEE measurements were slightly lower than those obtained on CT imaging, measurements of both projected MA area and perimeter showed excellent correlations, with small differences between the two modalities (r = 0.88 and r = 0.92, respectively, P < .0001). Correlations were significant but lower for MA diameters (r = 0.68–0.72, P < .0001) and mitroaortic angle (r = 0.53, P = .0001). Receiver operating characteristic curve analyses showed that 3D TEE imaging had a good ability to predict TMVR screening success, defined by constructors on the basis of CT measurements, with ranges of 12.9 to 15 cm2 for MA area (area under the curve [AUC] = 0.88–0.91, P < .0001), 128 to 139 mm for MA perimeter (AUC = 0.85–0.91, P < .0001), 35 to 39 mm for anteroposterior diameter (AUC = 0.79–0.84, P < .0001), and 37 to 42 mm for posteromedial-anterolateral diameter (AUC = 0.81–0.89, P < .0001). Three-dimensional TEE measurements of MA dimensions display strong correlations with CT measurements in patients undergoing TMVR screening. Three-dimensional TEE imaging should be proposed as a reasonable alternative to CT imaging in this vulnerable population. •3D TEE is feasible and useful to measure MA dimensions in patients referred for TMVR.•3D-TEE displays good interobserver agreement and correlations with CT measurements.•3D-TEE is highly accurate to predict TMVR screening success.