Open AccessThe fallacy of indexed effective orifice area charts to predict prosthesis–patient mismatch after prosthesis implantation
Author(s) -
Michiel D. Vriesendorp,
Rob A.F. De Lind Van Wijngaarden,
Stuart J. Head,
Arie Pieter Kappetein,
Graeme L. Hickey,
Vivek Rao,
Neil J. Weissman,
Michael J. Reardon,
Michael G. Moront,
Joseph F. Sabik,
Robert J.M. Klautz
Publication year - 2020
Publication title -
european heart journal. cardiovascular imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.576
H-Index - 92
eISSN - 2047-2412
pISSN - 2047-2404
DOI - 10.1093/ehjci/jeaa044
Subject(s) - medicine , aortic valve replacement , prosthesis , cardiology , aortic valve stenosis , aortic valve , stenosis , chart , surgery , statistics , mathematics
Aims Indexed effective orifice area (EOAi) charts are used to determine the likelihood of prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR). The aim of this study is to validate whether these EOAi charts, based on echocardiographic normal reference values, can accurately predict PPM. Methods and results In the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial, 986 patients with aortic valve stenosis/regurgitation underwent AVR with an Avalus valve. Patients were randomly split (50:50) into training and test sets. The mean measured EOAs for each valve size from the training set were used to create an Avalus EOAi chart. This chart was subsequently used to predict PPM in the test set and measures of diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) were assessed. PPM was defined by an EOAi ≤0.85 cm2/m2, and severe PPM was defined as EOAi ≤0.65 cm2/m2. The reference values obtained from the training set ranged from 1.27 cm2 for size 19 mm up to 1.81 cm2 for size 27 mm. The test set had an incidence of 66% of PPM and 24% of severe PPM. The EOAi chart inaccurately predicted PPM in 30% of patients and severe PPM in 22% of patients. For the prediction of PPM, the sensitivity was 87% and the specificity 37%. For the prediction of severe PPM, the sensitivity was 13% and the specificity 98%. Conclusion The use of echocardiographic normal reference values for EOAi charts to predict PPM is unreliable due to the large proportion of misclassifications.