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Three‐dimensional transesophageal echocardiography is an attractive alternative to cardiac multi‐detector computed tomography for aortic annular sizing: Systematic review and meta‐analysis
Author(s) -
Elkaryoni Ahmed,
Nanda Navin C.,
Baweja Paramdeep,
Arisha Mohammed J.,
Zamir Harris,
Elgebaly Ahmed,
Altibi Ahmed MA,
Sharma Rishi
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14147
Subject(s) - medicine , cardiac skeleton , radiology , cardiac imaging , nuclear medicine , meta analysis , gold standard (test) , aortic valve , cardiology , aortic valve replacement , stenosis
Background Cardiac imaging is the cornerstone of the pretranscatheter aortic valve replacement ( TAVR ) assessment. Multi‐detector computed tomography ( MDCT ) is considered the conventional imaging modality. However, there is still no definitive gold standard. Targeted cohort of inoperable high‐risk patients with underlying comorbidities, particularly renal impairment, makes apparent the need for MDCT alternative. We aimed to demonstrate the correlation extent between MDCT and three‐dimensional transesophageal echocardiography (3 DTEE ) aortic annular area measures and to answer the question: Is 3 DTEE a good alternative to MDCT ? Methods A systematic literature search and meta‐analysis were conducted to evaluate the degree of correlation and agreement between 3 DTEE and MDCT aortic annular sizing. A thorough assessment of EMBASE , PubMed, and Cochrane Central Register of Controlled Trials ( CENTRAL ) was performed. All studies comparing 3 DTEE and MDCT in relation to aortic annular sizing were included. Results Thirteen studies were included (N = 1228 patients). A strong linear correlation was found between 3 DTEE and MDCT measurements of aortic annulus area ( r = 0.84, P < 0.001), mean perimeter ( r = 0. 0.85, P < 0.001), and mean diameter ( r = 0.80, P < 0.001). Bland–Altman plots revealed smaller mean 3 DTEE values in comparison to MDCT for aortic annular area, the mean difference being −2.22 mm 2 with 95% limits of agreement −12.79 to 8.36. Conclusion Aortic annulus measurements obtained by 3 DTEE demonstrated a high level of correlation with those evaluated by MDCT . This makes 3 DTEE a feasible choice for aortic annulus assessment, with advantage of real time assessment, lack of contrast, and no radiation exposure.