Manual, semiautomated, and fully automated measurement of the aortic annulus for planning of transcatheter aortic valve replacement (TAVR/TAVI): Analysis of interchangeability

Junyang Lou, Nancy A. Obuchowski, Amar Krishnaswamy, Zoran Popovic, Scott D. Flamm, Samir R. Kapadia, Lars G. Svensson, Michael A. Bolen, Milind Y. Desai, Sandra S. Halliburton, E. Murat Tuzcu, Paul Schoenhagen

Research output: Contribution to journalArticle

Abstract

Background: Preprocedural 3-dimensional CT imaging of the aortic annular plane plays a critical role for transcatheter aortic valve replacement (TAVR) planning; however, manual reconstructions are complex. Automated analysis software may improve reproducibility and agreement between readers but is incompletely validated. Methods: In 110 TAVR patients (mean age, 81years; 37% female) undergoing preprocedural multidetector CT, automated reconstruction of the aortic annular plane and planimetry of the annulus was performed with a prototype of now commercially available software (syngo.CT Cardiac Function-Valve Pilot; Siemens Healthcare, Erlangen, Germany). Fully automated, semiautomated, and manual annulus measurements were compared. Intrareader and inter-reader agreement, intermodality agreement, and interchangeability were analyzed. Finally, the impact of these measurements on recommended valve size was evaluated. Results: Semiautomated analysis required major correction in 5 patients (4.5%). In the remaining 95.5%, only minor correction was performed. Mean manual annulus area was significantly smaller than fully automated results (P <.001 for both readers) but similar to semiautomated measurements (5.0 vs 5.4 vs 4.9cm2, respectively). The frequency of concordant recommendations for valve size increased if manual analysis was replaced with the semiautomated method (60% agreement was improved to 82.4%; 95% confidence interval for the difference [69.1%-83.4%]). Conclusions: Semiautomated aortic annulus analysis, with minor correction by the user, provides reliable results in the context of TAVR annulus evaluation.

Original languageEnglish (US)
Pages (from-to)42-49
Number of pages8
JournalJournal of Cardiovascular Computed Tomography
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Software
Heart Valves
Germany
Confidence Intervals
Delivery of Health Care
Transcatheter Aortic Valve Replacement

Keywords

  • Aortic annulus
  • Aortic stenosis
  • Computed tomography
  • Semi-automated analysis
  • TAVI
  • TAVR

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Manual, semiautomated, and fully automated measurement of the aortic annulus for planning of transcatheter aortic valve replacement (TAVR/TAVI) : Analysis of interchangeability. / Lou, Junyang; Obuchowski, Nancy A.; Krishnaswamy, Amar; Popovic, Zoran; Flamm, Scott D.; Kapadia, Samir R.; Svensson, Lars G.; Bolen, Michael A.; Desai, Milind Y.; Halliburton, Sandra S.; Tuzcu, E. Murat; Schoenhagen, Paul.

In: Journal of Cardiovascular Computed Tomography, Vol. 9, No. 1, 01.01.2015, p. 42-49.

Research output: Contribution to journalArticle

Lou, J, Obuchowski, NA, Krishnaswamy, A, Popovic, Z, Flamm, SD, Kapadia, SR, Svensson, LG, Bolen, MA, Desai, MY, Halliburton, SS, Tuzcu, EM & Schoenhagen, P 2015, 'Manual, semiautomated, and fully automated measurement of the aortic annulus for planning of transcatheter aortic valve replacement (TAVR/TAVI): Analysis of interchangeability', Journal of Cardiovascular Computed Tomography, vol. 9, no. 1, pp. 42-49. https://doi.org/10.1016/j.jcct.2014.11.003
Lou, Junyang ; Obuchowski, Nancy A. ; Krishnaswamy, Amar ; Popovic, Zoran ; Flamm, Scott D. ; Kapadia, Samir R. ; Svensson, Lars G. ; Bolen, Michael A. ; Desai, Milind Y. ; Halliburton, Sandra S. ; Tuzcu, E. Murat ; Schoenhagen, Paul. / Manual, semiautomated, and fully automated measurement of the aortic annulus for planning of transcatheter aortic valve replacement (TAVR/TAVI) : Analysis of interchangeability. In: Journal of Cardiovascular Computed Tomography. 2015 ; Vol. 9, No. 1. pp. 42-49.
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abstract = "Background: Preprocedural 3-dimensional CT imaging of the aortic annular plane plays a critical role for transcatheter aortic valve replacement (TAVR) planning; however, manual reconstructions are complex. Automated analysis software may improve reproducibility and agreement between readers but is incompletely validated. Methods: In 110 TAVR patients (mean age, 81years; 37{\%} female) undergoing preprocedural multidetector CT, automated reconstruction of the aortic annular plane and planimetry of the annulus was performed with a prototype of now commercially available software (syngo.CT Cardiac Function-Valve Pilot; Siemens Healthcare, Erlangen, Germany). Fully automated, semiautomated, and manual annulus measurements were compared. Intrareader and inter-reader agreement, intermodality agreement, and interchangeability were analyzed. Finally, the impact of these measurements on recommended valve size was evaluated. Results: Semiautomated analysis required major correction in 5 patients (4.5{\%}). In the remaining 95.5{\%}, only minor correction was performed. Mean manual annulus area was significantly smaller than fully automated results (P <.001 for both readers) but similar to semiautomated measurements (5.0 vs 5.4 vs 4.9cm2, respectively). The frequency of concordant recommendations for valve size increased if manual analysis was replaced with the semiautomated method (60{\%} agreement was improved to 82.4{\%}; 95{\%} confidence interval for the difference [69.1{\%}-83.4{\%}]). Conclusions: Semiautomated aortic annulus analysis, with minor correction by the user, provides reliable results in the context of TAVR annulus evaluation.",
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AU - Obuchowski, Nancy A.

AU - Krishnaswamy, Amar

AU - Popovic, Zoran

AU - Flamm, Scott D.

AU - Kapadia, Samir R.

AU - Svensson, Lars G.

AU - Bolen, Michael A.

AU - Desai, Milind Y.

AU - Halliburton, Sandra S.

AU - Tuzcu, E. Murat

AU - Schoenhagen, Paul

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N2 - Background: Preprocedural 3-dimensional CT imaging of the aortic annular plane plays a critical role for transcatheter aortic valve replacement (TAVR) planning; however, manual reconstructions are complex. Automated analysis software may improve reproducibility and agreement between readers but is incompletely validated. Methods: In 110 TAVR patients (mean age, 81years; 37% female) undergoing preprocedural multidetector CT, automated reconstruction of the aortic annular plane and planimetry of the annulus was performed with a prototype of now commercially available software (syngo.CT Cardiac Function-Valve Pilot; Siemens Healthcare, Erlangen, Germany). Fully automated, semiautomated, and manual annulus measurements were compared. Intrareader and inter-reader agreement, intermodality agreement, and interchangeability were analyzed. Finally, the impact of these measurements on recommended valve size was evaluated. Results: Semiautomated analysis required major correction in 5 patients (4.5%). In the remaining 95.5%, only minor correction was performed. Mean manual annulus area was significantly smaller than fully automated results (P <.001 for both readers) but similar to semiautomated measurements (5.0 vs 5.4 vs 4.9cm2, respectively). The frequency of concordant recommendations for valve size increased if manual analysis was replaced with the semiautomated method (60% agreement was improved to 82.4%; 95% confidence interval for the difference [69.1%-83.4%]). Conclusions: Semiautomated aortic annulus analysis, with minor correction by the user, provides reliable results in the context of TAVR annulus evaluation.

AB - Background: Preprocedural 3-dimensional CT imaging of the aortic annular plane plays a critical role for transcatheter aortic valve replacement (TAVR) planning; however, manual reconstructions are complex. Automated analysis software may improve reproducibility and agreement between readers but is incompletely validated. Methods: In 110 TAVR patients (mean age, 81years; 37% female) undergoing preprocedural multidetector CT, automated reconstruction of the aortic annular plane and planimetry of the annulus was performed with a prototype of now commercially available software (syngo.CT Cardiac Function-Valve Pilot; Siemens Healthcare, Erlangen, Germany). Fully automated, semiautomated, and manual annulus measurements were compared. Intrareader and inter-reader agreement, intermodality agreement, and interchangeability were analyzed. Finally, the impact of these measurements on recommended valve size was evaluated. Results: Semiautomated analysis required major correction in 5 patients (4.5%). In the remaining 95.5%, only minor correction was performed. Mean manual annulus area was significantly smaller than fully automated results (P <.001 for both readers) but similar to semiautomated measurements (5.0 vs 5.4 vs 4.9cm2, respectively). The frequency of concordant recommendations for valve size increased if manual analysis was replaced with the semiautomated method (60% agreement was improved to 82.4%; 95% confidence interval for the difference [69.1%-83.4%]). Conclusions: Semiautomated aortic annulus analysis, with minor correction by the user, provides reliable results in the context of TAVR annulus evaluation.

KW - Aortic annulus

KW - Aortic stenosis

KW - Computed tomography

KW - Semi-automated analysis

KW - TAVI

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