Journal Article

22 Prevalence of severe aortic valve stenosis in patients referred for transcatheter aortic valve implantation by echocardiographic and CT parameters, and their diagnostic accuracy

Hothi, Sandeep, Mittal, Tarun, Mirsadraee, Saeed, Sabarwal, Kivraj, Ariff, Ben

2025

Overview

ObjectivesTo explore the prevalence and discrepancy in the diagnosis of severe AS (aortic stenosis) by echocardiography in patients referred for TAVI-CT (Transcatheter Aortic valve Implantation CT) and accuracy of CT-AVCS (CT-Aortic valve calcium score) and CT-AVA (CT-aortic valve area) compared to echocardiographic mean gradient (MG) in patients with normal function and flow.Methods1150 patients from three centres who underwent TAVI-CT systolic phase ECG-gating were identified. Patients with previous aortic valve surgery, aortic, or mitral regurgitation were excluded. Patients with left ventricular ejection fraction ≥ 50% and normal indexed stroke volume (28–48 ml/m2) were selected. CT-AVA was obtained by direct planimetry. Accuracy of echo and CT parameters for predicting stenosis severity against MG ≥40 mmHg was determined.ResultsA total of 428 patients (54% women) with a mean age of 81 years (±7.5) fulfilled the inclusion criteria (Table 1). Severe AS by EVA (Echo valve area) ≤1 cm2, peak velocity ≥4 m2, and MG ≥40 mmHg, was present in 95%, 56%, and 56% patients respectively. Severe AS defined by AVCS ≥3000 in men, AVCS ≥2000 in women, and CT-AVA ≤1 cm2 was present in 53%, 59%, and 59% with AUC of AVCS and CT-AVA being (AUC, 0.72–0.74) and (0.69) respectively.ConclusionMost patients referred for TAVI have severe AS defined by EVA with high discrepancy compared to MG. CT-AVCS and CT-AVA are flow-independent parameters with least discrepancy with MG.

• Publisher: BMJ Publishing Group LTD
• Subject: Accuracy