Intra- and Inter-Observer Reproducibility of Transcatheter Aortic Valve Replacement Planning Measurements by Multidetector Computed Tomography.

Abstract

BACKGROUND AND AIM OF THE STUDY: Multidetector computed tomography (MDCT) is widely used for transcatheter aortic valve replacement (TAVR) planning, and its use predicts and prevents complications. To date, the reproducibility of aortoiliofemoral measurements and prediction of fluoroscopic angles for TAVR deployment remain inadequately studied. METHODS: Twenty-five consecutive patients (six males, 19 females; mean age 81.1 years) undergoing pre-procedural evaluation for TAVR were studied for 74 separate variables by MDCT. Two experienced readers made repeated measurements of the diameter and area of the aortic annulus, the aortic root at the level of the sinuses of Valsalva, sinotubular junction, and ascending aorta, and the diameters of peripheral vessels at the level of the distal abdominal aorta, and the iliofemoral arteries. A fluoroscopic angle prediction was obtained for left anterior oblique (LAO) 0 degrees, 20 degrees and 30 degrees projections. Pearson's correlation coefficient (r) was obtained, and intra-class correlation coefficients and Bland-Altman plots were generated to examine agreements, respectively. RESULTS: The mean aortic valve area was 0.7 cm2. Each measurement generally showed good intra- and inter-observer reproducibility. The mean difference between readers was -0.3 mm for mean annular diameter and 3.6 mm2 for annular area. The area- derived diameter showed better reproducibility than the mean diameter (ICC 0.87, 0.84). However, the right coronary artery height showed poor inter-observer agreement (ICC 0.48). Angle predictions for 0 degrees, 20 degrees and 30 degrees-LAO were reproducible within and between readers (ICC 0.68-0.96 and 0.75-0.85). Qualitative assessments were also reliable between readers. CONCLUSION: Inter- and intra-observer measurements of the pre-TAVR planning parameters are reliable, with generally a high degree of agreement.