Skip to main content
Erschienen in: Heart and Vessels 5/2017

13.10.2016 | Original Article

Geometrical characteristics of aortic root and left ventricular dysfunction in aortic stenosis: quantification of 256-slice coronary CT angiography

verfasst von: Michinobu Nagao, Yuzo Yamasaki, Takeshi Kamitani, Satoshi Kawanami, Masatoshi Kondo, Hiromichi Sonoda, Taisuke Fujioka, Hiroshi Honda

Erschienen in: Heart and Vessels | Ausgabe 5/2017

Einloggen, um Zugang zu erhalten

Abstract

The purpose of this study is to analyze the geometrical characteristics of aortic root and left ventricular (LV) function in aortic stenosis (AS) using 256-slice coronary-computed tomography angiography (CCTA). Retrospective ECG-gated 256-slice CCTA data from 32 patients with tricuspid AS scheduled for aortic valve replacement, and 11 controls were analyzed. Aortic root geometry was measured using multiplanar reconstruction CT images. CCTA data set was transformed into 100 phases/cycle using motion coherence image processing. Systolic shortening (SS, mm/ms) and diastolic relaxation (DR, mm/ms2) in the circumferential and longitudinal directions on time curves of myocardial length were calculated, and were used as estimates of geometric LV function. Comparison of parameters was analyzed by Mann–Whitney U test. Receiver-operating-characteristic (ROC) analysis was performed to determine the optimal cutoff of parameters for differentiating AS patients. Height of the right coronary cusp was significantly lower for AS patients than controls (11.4 ± 2.4 vs. 13.9 ± 2.0 mm/m2, p < 0.005). Vertical–longitudinal SS was significantly lower for AS patients than for controls (1.7 ± 0.8 vs. 2.7 ± 0.7 mm/ms/m2, p < 0.001). ROC analysis revealed optimal height of the right coronary cusp of 12.4 mm/m2 and vertical–longitudinal SS of 2.4 mm/ms/m2 for differentiating AS patients from controls, with C statistics of 0.82 and 0.85. In AS patients, ROC analysis revealed optimal vertical–longitudinal DR of 0.05 mm/ms2/m2 for predicting patients with stroke volume index <35 ml with C statistics of 0.93. Quantification of CCTA demonstrates that AS is characterized by small coronary cusps as aortic root remodeling and vertical–longitudinal LV dysfunction related to restrictive physiology.
Literatur
1.
Zurück zum Zitat Rajappan K, Rimoldi OE, Dutka DP, Ariff B, Pennell DJ, Sheridan DJ, Camici PG (2002) Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries. Circulation 105:470–476CrossRefPubMed Rajappan K, Rimoldi OE, Dutka DP, Ariff B, Pennell DJ, Sheridan DJ, Camici PG (2002) Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries. Circulation 105:470–476CrossRefPubMed
2.
Zurück zum Zitat Tzivoni D (1993) Effect of transient ischaemia on left ventricular function and prognosis. Eur Heart J 14 Suppl A:2–7CrossRefPubMed Tzivoni D (1993) Effect of transient ischaemia on left ventricular function and prognosis. Eur Heart J 14 Suppl A:2–7CrossRefPubMed
3.
Zurück zum Zitat Krayenbuehl HP, Hess OM, Ritter M, Monrad ES, Hoppeler H (1988) Left ventricular systolic function in aortic stenosis. Eur Heart J 9 Suppl E:19–23CrossRefPubMed Krayenbuehl HP, Hess OM, Ritter M, Monrad ES, Hoppeler H (1988) Left ventricular systolic function in aortic stenosis. Eur Heart J 9 Suppl E:19–23CrossRefPubMed
4.
Zurück zum Zitat Aurigemma GP, Silver KH, Priest MA, Gaasch WH (1995) Geometric changes allow normal ejection fraction despite depressed myocardial shortening in hypertensive left ventricular hypertrophy. J Am Coll Cardiol 26:195–202CrossRefPubMed Aurigemma GP, Silver KH, Priest MA, Gaasch WH (1995) Geometric changes allow normal ejection fraction despite depressed myocardial shortening in hypertensive left ventricular hypertrophy. J Am Coll Cardiol 26:195–202CrossRefPubMed
5.
Zurück zum Zitat Calleja A, Thavendiranathan P, Ionasec RI, Houle H, Liu S, Volgt I, Sudhakar CS, Crestanello J, Ryan T, Vannan MA (2013) Automated quantitative 3-dimensional modeling of the aortic valve and root by 3-dimensional transesophageal echocardiography in normal, aortic regurgitation, and aortic stenosis: comparison to computed tomography in normal and clinical implications. Circ Cardiovasc Imaging 6:99–108CrossRefPubMed Calleja A, Thavendiranathan P, Ionasec RI, Houle H, Liu S, Volgt I, Sudhakar CS, Crestanello J, Ryan T, Vannan MA (2013) Automated quantitative 3-dimensional modeling of the aortic valve and root by 3-dimensional transesophageal echocardiography in normal, aortic regurgitation, and aortic stenosis: comparison to computed tomography in normal and clinical implications. Circ Cardiovasc Imaging 6:99–108CrossRefPubMed
6.
Zurück zum Zitat Takami Y, Tajima K (2016) Mitral annular calcification in patients undergoing aortic valve replacement for aortic valve stenosis. Heart Vessels 31:183–188CrossRefPubMed Takami Y, Tajima K (2016) Mitral annular calcification in patients undergoing aortic valve replacement for aortic valve stenosis. Heart Vessels 31:183–188CrossRefPubMed
7.
Zurück zum Zitat Feuchtner GM, Muller S, Bonatti J, Schachner T, Velik-Salchner C, Pachinger O, Dichti W (2007) Sixty-four slice CT evaluation of aortic stenosis using planimetry of the aortic valve area. Am J Roentgenol 189:197–203CrossRef Feuchtner GM, Muller S, Bonatti J, Schachner T, Velik-Salchner C, Pachinger O, Dichti W (2007) Sixty-four slice CT evaluation of aortic stenosis using planimetry of the aortic valve area. Am J Roentgenol 189:197–203CrossRef
8.
Zurück zum Zitat Messika-Zeitoun D, Serfaty JM, Brochet E, Ducrocq G, Lepage L, Detaint D, Hyafil F, Himbert D, Pasi N, Laissy JP, Lung B, Vahanian A (2010) Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. J Am Coll Cardiol 55:186–194CrossRefPubMed Messika-Zeitoun D, Serfaty JM, Brochet E, Ducrocq G, Lepage L, Detaint D, Hyafil F, Himbert D, Pasi N, Laissy JP, Lung B, Vahanian A (2010) Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. J Am Coll Cardiol 55:186–194CrossRefPubMed
9.
Zurück zum Zitat Kondo M, Nagao M, Yonezawa M, Yamasaki Y, Shirasaka T, Nakamura Y, Honda H (2014) Improvement of automated right ventricular segmentation using dual-bolus contrast media injection with 256-slice coronary CT angiography. Acad Radiol 21:648–653CrossRefPubMed Kondo M, Nagao M, Yonezawa M, Yamasaki Y, Shirasaka T, Nakamura Y, Honda H (2014) Improvement of automated right ventricular segmentation using dual-bolus contrast media injection with 256-slice coronary CT angiography. Acad Radiol 21:648–653CrossRefPubMed
10.
Zurück zum Zitat Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Lung B, Otto CM, Pellikka PA, Quinones M (2009) Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr 10:1–25CrossRefPubMed Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Lung B, Otto CM, Pellikka PA, Quinones M (2009) Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr 10:1–25CrossRefPubMed
11.
Zurück zum Zitat Greenberg NL, Firstenberg MS, Castro PL, Main M, Travaglini A, Odabashian JA, Drinko JK, Rodriguez LL, Thomas JD, Garcia MJ (2002) Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation 105:99–105CrossRefPubMed Greenberg NL, Firstenberg MS, Castro PL, Main M, Travaglini A, Odabashian JA, Drinko JK, Rodriguez LL, Thomas JD, Garcia MJ (2002) Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation 105:99–105CrossRefPubMed
12.
Zurück zum Zitat Dahl JS, Videbak L, Poulsen MK, Rudbak TR, Pellikka PA, Moller JE (2012) Global strain in severe aortic valve stenosis relation to clinical outcome after aortic valve replacement. Circ Cardiovasc Imaging 5:613–620CrossRefPubMed Dahl JS, Videbak L, Poulsen MK, Rudbak TR, Pellikka PA, Moller JE (2012) Global strain in severe aortic valve stenosis relation to clinical outcome after aortic valve replacement. Circ Cardiovasc Imaging 5:613–620CrossRefPubMed
13.
Zurück zum Zitat Delgado V, Ng AC, Schuijf JD, van der Kley F, Shanks M, Tops LF, van de Veire NR, de Roos A, Kroft LJ, Schalij MJ, Bax JJ (2011) Automated assessment of the aortic root dimensions with multidetector row computed tomography. Ann Thoac Surg 91:716–723CrossRef Delgado V, Ng AC, Schuijf JD, van der Kley F, Shanks M, Tops LF, van de Veire NR, de Roos A, Kroft LJ, Schalij MJ, Bax JJ (2011) Automated assessment of the aortic root dimensions with multidetector row computed tomography. Ann Thoac Surg 91:716–723CrossRef
14.
Zurück zum Zitat Pontone G, Andreini D, Bartorelli AL, Annoni A, Mushtaq S, Bertella E, Formenti A, Cortinovis S, Alamanni F, Fusari M, Bona V, Tamborini G, Muratori M, Ballerini G, Fiorentini C, Biglioli P, Pepi M (2011) Feasibility and accuracy of a comprehensive multidetector computed tomography acquisition for patients referred for balloon-expandable transcatheter aortic valve implantation. Am Heart J 161:1106–1113CrossRefPubMed Pontone G, Andreini D, Bartorelli AL, Annoni A, Mushtaq S, Bertella E, Formenti A, Cortinovis S, Alamanni F, Fusari M, Bona V, Tamborini G, Muratori M, Ballerini G, Fiorentini C, Biglioli P, Pepi M (2011) Feasibility and accuracy of a comprehensive multidetector computed tomography acquisition for patients referred for balloon-expandable transcatheter aortic valve implantation. Am Heart J 161:1106–1113CrossRefPubMed
15.
Zurück zum Zitat Tops LF, Wood DA, Delgado V, Schuijf JD, Mayo JR, Pasupati S, Lamers FP, van der Wall EE, Schalij MJ, Webb JG, Bax JJ (2008) Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging 1(3):321–330CrossRefPubMed Tops LF, Wood DA, Delgado V, Schuijf JD, Mayo JR, Pasupati S, Lamers FP, van der Wall EE, Schalij MJ, Webb JG, Bax JJ (2008) Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging 1(3):321–330CrossRefPubMed
16.
Zurück zum Zitat Akhtar M, Tuzcu EM, Kapadia SR, Svensson LG, Greenberg RK, Roselli EE, Halliburton S, Kurra V, Schoenhagen P, Sola S (2009) Aortic root morphology in patients undergoing percutaneous aortic valve replacement: evidence of aortic root remodeling. J Thorac Cardiovasc Surg 137:950–956CrossRefPubMed Akhtar M, Tuzcu EM, Kapadia SR, Svensson LG, Greenberg RK, Roselli EE, Halliburton S, Kurra V, Schoenhagen P, Sola S (2009) Aortic root morphology in patients undergoing percutaneous aortic valve replacement: evidence of aortic root remodeling. J Thorac Cardiovasc Surg 137:950–956CrossRefPubMed
17.
Zurück zum Zitat Chien-Chia Wu V, Kaku K, Takeuchi M, Otani K, Yoshitani H, Tamura M, Abe H, Lin FC, Otsuji Y (2014) Aortic root geometry in patients with aortic stenosis assessed by real-time three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 27:32–41CrossRef Chien-Chia Wu V, Kaku K, Takeuchi M, Otani K, Yoshitani H, Tamura M, Abe H, Lin FC, Otsuji Y (2014) Aortic root geometry in patients with aortic stenosis assessed by real-time three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 27:32–41CrossRef
18.
Zurück zum Zitat Gelsomina S, Luca F, Parise O, Lorusso R, Rao CM, Vizzardi E, Gensini GF, Maessen JG (2013) Longitudinal strain predicts left ventricular mass regression after aortic valve replacement for severe aortic stenosis and preserved left ventricular function. Heart Vessels 28:775–784CrossRef Gelsomina S, Luca F, Parise O, Lorusso R, Rao CM, Vizzardi E, Gensini GF, Maessen JG (2013) Longitudinal strain predicts left ventricular mass regression after aortic valve replacement for severe aortic stenosis and preserved left ventricular function. Heart Vessels 28:775–784CrossRef
19.
Zurück zum Zitat Dumesnil JG, Pibarot P, Carabello B (2010) Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implication for diagnosis and treatment. Eur Heart J 31:281–289CrossRefPubMed Dumesnil JG, Pibarot P, Carabello B (2010) Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implication for diagnosis and treatment. Eur Heart J 31:281–289CrossRefPubMed
20.
Zurück zum Zitat Eleid MF, Sorajja P, Michelena HI, Malouf JF, Scott CG, Pellikka PA (2013) Flow-gradient patterns in severe aortic stenosis with preserved ejection fraction: clinical characteristics and predictors of survival. Circulation 128:1781–1789CrossRefPubMedPubMedCentral Eleid MF, Sorajja P, Michelena HI, Malouf JF, Scott CG, Pellikka PA (2013) Flow-gradient patterns in severe aortic stenosis with preserved ejection fraction: clinical characteristics and predictors of survival. Circulation 128:1781–1789CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Lancellotti P, Magne J, Donal E, Davin L, O’Connor K, Rosca M, Szymanski C, Cosyns B, Pierard LA (2012) Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification. J Am Coll Cardiol 59:235–243CrossRefPubMed Lancellotti P, Magne J, Donal E, Davin L, O’Connor K, Rosca M, Szymanski C, Cosyns B, Pierard LA (2012) Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification. J Am Coll Cardiol 59:235–243CrossRefPubMed
22.
Zurück zum Zitat Adda J, Mielot C, Giorgi R, Cransac F, Zirphile X, Donal E, Sportouch-Dukhan C, Réant P, Laffitte S, Cade S, Le Dolley Y, Thuny F, Touboul N, Lavoute C, Avierinos JF, Lancellotti P, Habib G (2012) Low-flow, low-gradient severe aortic stenosis despite normal ejection fraction is associated with severe left ventricular dysfunction as assessed by speckle-tracking echocardiography: a multicenter study. Circ Cardiovasc Imaging 5:27–35CrossRefPubMed Adda J, Mielot C, Giorgi R, Cransac F, Zirphile X, Donal E, Sportouch-Dukhan C, Réant P, Laffitte S, Cade S, Le Dolley Y, Thuny F, Touboul N, Lavoute C, Avierinos JF, Lancellotti P, Habib G (2012) Low-flow, low-gradient severe aortic stenosis despite normal ejection fraction is associated with severe left ventricular dysfunction as assessed by speckle-tracking echocardiography: a multicenter study. Circ Cardiovasc Imaging 5:27–35CrossRefPubMed
23.
Zurück zum Zitat Mehrotra P, Jansen K, Flynn AW, Tan TC, Elmariah S, Picard MH, Hung J (2013) Differential left ventricular remodelling and longitudinal function distinguishes low flow from normal-flow preserved ejection fraction lowgradient severe aortic stenosis. Eur Heart J 34:1906–1914CrossRefPubMedPubMedCentral Mehrotra P, Jansen K, Flynn AW, Tan TC, Elmariah S, Picard MH, Hung J (2013) Differential left ventricular remodelling and longitudinal function distinguishes low flow from normal-flow preserved ejection fraction lowgradient severe aortic stenosis. Eur Heart J 34:1906–1914CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Dumesnil JG, Shoucri RM (1982) Effect of the geometry of the left ventricle on the calculation of ejection fraction. Circulation 65:91–98CrossRefPubMed Dumesnil JG, Shoucri RM (1982) Effect of the geometry of the left ventricle on the calculation of ejection fraction. Circulation 65:91–98CrossRefPubMed
25.
Zurück zum Zitat Nagao M, Hatakenaka M, Matsuo Y, Kamitani T, Higuchi K, Shikata F, Nagashima M, Mochizuki T, Honda H (2012) Subendocardial contractile impairment in chronic ischemic myocardium: assessment by strain analysis of 3T tagged CMR. J Cardiovasc Magn Reson 14(1):14CrossRefPubMedPubMedCentral Nagao M, Hatakenaka M, Matsuo Y, Kamitani T, Higuchi K, Shikata F, Nagashima M, Mochizuki T, Honda H (2012) Subendocardial contractile impairment in chronic ischemic myocardium: assessment by strain analysis of 3T tagged CMR. J Cardiovasc Magn Reson 14(1):14CrossRefPubMedPubMedCentral
26.
Metadaten
Titel
Geometrical characteristics of aortic root and left ventricular dysfunction in aortic stenosis: quantification of 256-slice coronary CT angiography
verfasst von
Michinobu Nagao
Yuzo Yamasaki
Takeshi Kamitani
Satoshi Kawanami
Masatoshi Kondo
Hiromichi Sonoda
Taisuke Fujioka
Hiroshi Honda
Publikationsdatum
13.10.2016
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 5/2017
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-016-0902-2

Weitere Artikel der Ausgabe 5/2017

Heart and Vessels 5/2017 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.