Advertisement

Comparison of Cardiac Computed Tomographic Angiography to Transesophageal Echocardiography for Evaluation of Patients With Native Valvular Heart Disease

Published:September 28, 2009DOI:https://doi.org/10.1016/j.amjcard.2009.06.066
      Retrospectively gated helical cardiac computed tomographic angiography (CCTA) has been reported accurate in the evaluation of isolated valvular abnormalities, but its ability to provide comprehensive assessment of common valvular lesions is not established. We evaluated 56 consecutive patients undergoing 64-detector retrospective electrocardiogram-gated CCTA and transesophageal echocardiography for the presence of aortic and mitral stenoses, aortic and mitral regurgitations, mitral valve prolapse, and tricuspid regurgitation. Two cardiac computed tomographic angiographic readers measured maximum aortic and mitral valve opening areas, assessed for aortic or mitral valve regurgitant area, and evaluated for mitral valve prolapse. Tricuspid regurgitation was assessed by the contrast ratio of the inferior vena cava to the right heart. After excluding nondiagnostic valves on CCTA (mitral valve n = 4, aortic valve n = 2), the sensitivity, specificity, positive predictive values, and negative predictive values of CCTA compared to transesophageal echocardiography were 100%, 96%, 50%, and 100% for aortic stenosis, 44%, 96%, 67%, and 90% for aortic regurgitation, 100% each for mitral stenosis, 13%, 95%, 80%, and 45% for mitral regurgitation, and 50%, 98%, 80%, and 91% for mitral valve prolapse. There was no relation between tricuspid regurgitation grade and contrast ratio (p = 0.53). There was excellent interobserver agreement for aortic and mitral stenoses (kappa = 1.0 for each), and good agreement for aortic regurgitation, mitral regurgitation, and mitral valve prolapse (kappa = 0.81, 0.78, and 0.88, respectively). In conclusion, CCTA exhibited high diagnostic performance for detection of aortic and mitral stenoses and limited diagnostic performance for aortic regurgitation, mitral regurgitation, and mitral valve prolapse; tricuspid regurgitation could not be evaluated. The ability of CCTA to provide comprehensive assessment of valvular function is variable.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Budoff M.J.
        • Dowe D.
        • Jollis J.G.
        • Gitter M.
        • Sutherland J.
        • Halamert E.
        • Scherer M.
        • Bellinger R.
        • Martin A.
        • Benton R.
        • Delago A.
        • Min J.K.
        Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial.
        J Am Coll Cardiol. 2008; 52: 1724-1732
        • LaBounty T.M.
        • Sundaram B.
        • Agarwal P.
        • Armstrong W.A.
        • Kazerooni E.A.
        • Yamada E.
        Aortic valve area on 64-MDCT correlates with transesophageal echocardiography in aortic stenosis.
        Am J Roentgenol. 2008; 191: 1652-1658
        • Bonow R.O.
        Valvular heart disease.
        in: Zipes D.P. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 7th Ed. Elsevier Saunders, Philadelphia, PA2005: 1553-1632
        • Devereux R.B.
        • Jones E.C.
        • Roman M.J.
        • Howard B.V.
        • Fabsitz R.R.
        • Liu J.E.
        • Palmieri V.
        • Welty T.K.
        • Lee E.T.
        Prevalence and correlates of mitral valve prolapse in a population-based sample of American Indians: the Strong Heart Study.
        Am J Med. 2001; 111: 679-685
        • Groves A.M.
        • Win T.
        • Charman S.C.
        • Wisbey C.
        • Pepke-Zaba J.
        • Coulden R.A.
        Semi-quantitative assessment of tricuspid regurgitation on contrast-enhanced multidetector CT.
        Clin Radiol. 2004; 59: 715-719
        • Otto C.M.
        Transesophageal echocardiography.
        in: Textbook of Clinical Echocardiography. 3rd Ed. Elsevier Saunders, Philadelphia, PA2004: 70-94
        • Bonow R.O.
        • Carabello B.A.
        • Chatterjee K.
        • de Leon Jr, A.C.
        • Faxon D.P.
        • Freed M.D.
        • Gaasch W.H.
        • Lytle B.W.
        • Nishimura R.A.
        • O'Gara P.T.
        • O'Rourke R.A.
        • Otto C.M.
        • Shah P.M.
        • Shanewise J.S.
        • Smith Jr, S.C.
        • Jacobs A.K.
        • Adams C.D.
        • Anderson J.L.
        • Antman E.M.
        • Fuster V.
        • Halperin J.L.
        • Hiratzka L.F.
        • Hunt S.A.
        • Nishimura R.
        • Page R.L.
        • Riegel B.
        ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons.
        J Am Coll Cardiol. 2006; 48: e1-e148
        • Zoghbi W.A.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • Kraft C.D.
        • Levine R.A.
        • Nihoyannopoulos P.
        • Otto C.M.
        • Quinones M.A.
        • Rakowski H.
        • Stewart W.J.
        • Waggoner A.
        • Weissman N.J.
        Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
        J Am Soc Echocardiogr. 2003; 16: 777-802
        • Castello R.
        • Fagan Jr, L.
        • Lenzen P.
        • Pearson A.C.
        • Labovitz A.J.
        Comparison of transthoracic and transesophageal echocardiography for assessment of left-sided valvular regurgitation.
        Am J Cardiol. 1991; 68: 1677-1680
        • Otto C.M.
        Principles of Echocardiographic Image Acquisition and Doppler Analysis Textbook of Clinical Echocardiography.
        in: Elsevier Saunders, Philadelphia, PA2004: 1-29
        • Achenbach S.
        • Ropers D.
        • Kuettner A.
        • Flohr T.
        • Ohnesorge B.
        • Bruder H.
        • Theessen H.
        • Karakaya M.
        • Daniel W.G.
        • Bautz W.
        • Kalender W.A.
        • Anders K.
        Contrast-enhanced coronary artery visualization by dual-source computed tomography—initial experience.
        Eur J Radiol. 2006; 57: 331-335
        • Feuchtner G.M.
        • Dichtl W.
        • Friedrich G.J.
        • Frick M.
        • Alber H.
        • Schachner T.
        • Bonatti J.
        • Mallouhi A.
        • Frede T.
        • Pachinger O.
        • zur Nedden D.
        • Muller S.
        Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity.
        J Am Coll Cardiol. 2006; 47: 1410-1417
        • Bouvier E.
        • Logeart D.
        • Sablayrolles J.L.
        • Feignoux J.
        • Scheuble C.
        • Touche T.
        • Thabut G.
        • Cohen-Solal A.
        Diagnosis of aortic valvular stenosis by multislice cardiac computed tomography.
        Eur Heart J. 2006; 27: 3033-3038
        • Alkadhi H.
        • Wildermuth S.
        • Plass A.
        • Bettex D.
        • Baumert B.
        • Leschka S.
        • Desbiolles L.M.
        • Marincek B.
        • Boehm T.
        Aortic stenosis: comparative evaluation of 16-detector row CT and echocardiography.
        Radiology. 2006; 240: 47-55
        • Laissy J.P.
        • Messika-Zeitoun D.
        • Serfaty J.M.
        • Sebban V.
        • Schouman-Claeys E.
        • Iung B.
        • Vahanian A.
        Comprehensive evaluation of preoperative patients with aortic valve stenosis: usefulness of cardiac multidetector computed tomography.
        Heart. 2007; 93: 1121-1125
        • Feuchtner G.M.
        • Muller S.
        • Bonatti J.
        • Schachner T.
        • Velik-Salchner C.
        • Pachinger O.
        • Dichtl W.
        Sixty-four slice CT evaluation of aortic stenosis using planimetry of the aortic valve area.
        Am J Roentgenol. 2007; 189: 197-203
        • Habis M.
        • Daoud B.
        • Roger V.L.
        • Ghostine S.
        • Caussin C.
        • Ramadan R.
        • Nottin R.
        • Lancelin B.
        • Angel C.Y.
        • Capderou A.
        • Paul J.F.
        Comparison of 64-slice computed tomography planimetry and Doppler echocardiography in the assessment of aortic valve stenosis.
        J Heart Valve Dis. 2007; 16: 216-224
        • Lembcke A.
        • Thiele H.
        • Lachnitt A.
        • Enzweiler C.N.
        • Wagner M.
        • Hein P.A.
        • Eddicks S.
        • Kivelitz D.E.
        Precision of forty slice spiral computed tomography for quantifying aortic valve stenosis: comparison with echocardiography and validation against cardiac catheterization.
        Invest Radiol. 2008; 43: 719-728
        • Lembcke A.
        • Kivelitz D.E.
        • Borges A.C.
        • Lachnitt A.
        • Hein P.A.
        • Dohmen P.M.
        • Thiele H.
        Quantification of aortic valve stenosis: head-to-head comparison of 64-slice spiral computed tomography with transesophageal and transthoracic echocardiography and cardiac catheterization.
        Invest Radiol. 2009; 44: 7-14
        • Messika-Zeitoun D.
        • Serfaty J.M.
        • Laissy J.P.
        • Berhili M.
        • Brochet E.
        • Iung B.
        • Vahanian A.
        Assessment of the mitral valve area in patients with mitral stenosis by multislice computed tomography.
        J Am Coll Cardiol. 2006; 48: 411-413
        • Jassal D.S.
        • Shapiro M.D.
        • Neilan T.G.
        • Chaithiraphan V.
        • Ferencik M.
        • Teague S.D.
        • Brady T.J.
        • Isselbacher E.M.
        • Cury R.C.
        64-Slice multidetector computed tomography (MDCT) for detection of aortic regurgitation and quantification of severity.
        Invest Radiol. 2007; 42: 507-512
        • Feuchtner G.M.
        • Dichtl W.
        • Muller S.
        • Jodocy D.
        • Schachner T.
        • Klauser A.
        • Bonatti J.O.
        64-MDCT for diagnosis of aortic regurgitation in patients referred to CT coronary angiography.
        Am J Roentgenol. 2008; 191: W1-W7
        • Alkadhi H.
        • Desbiolles L.
        • Husmann L.
        • Plass A.
        • Leschka S.
        • Scheffel H.
        • Vachenauer R.
        • Schepis T.
        • Gaemperli O.
        • Flohr T.G.
        • Genoni M.
        • Marincek B.
        • Jenni R.
        • Kaufmann P.A.
        • Frauenfelder T.
        Aortic regurgitation: assessment with 64-section CT.
        Radiology. 2007; 245: 111-121
        • Alkadhi H.
        • Wildermuth S.
        • Bettex D.A.
        • Plass A.
        • Baumert B.
        • Leschka S.
        • Desbiolles L.M.
        • Marincek B.
        • Boehm T.
        Mitral regurgitation: quantification with 16-detector row CT—initial experience.
        Radiology. 2006; 238: 454-463
        • Yeh B.M.
        • Kurzman P.
        • Foster E.
        • Qayyum A.
        • Joe B.
        • Coakley F.
        Clinical relevance of retrograde inferior vena cava or hepatic vein opacification during contrast-enhanced CT.
        Am J Roentgenol. 2004; 183: 1227-1232
        • Delgado V.
        • Tops L.F.
        • Schuijf J.D.
        • de Roos A.
        • Brugada J.
        • Schalij M.J.
        • Thomas J.D.
        • Bax J.J.
        Assessment of mitral valve anatomy and geometry with multislice computed tomography.
        JACC Cardiovasc Imaging. 2009; 2: 556-565
        • Wood D.A.
        • Tops L.F.
        • Mayo J.R.
        • Pasupati S.
        • Schalij M.J.
        • Humphries K.
        • Lee M.
        • Al Ali A.
        • Munt B.
        • Moss R.
        • Thompson C.R.
        • Bax J.J.
        • Webb J.G.
        Role of multislice computed tomography in transcatheter aortic valve replacement.
        Am J Cardiol. 2009; 103: 1295-1301