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The ratio of measured and reference effective orifice areas for discriminating prosthetic aortic valve obstruction

Authors
 Kyu Kim  ;  Dae-Young Kim  ;  Jiwon Seo  ;  Iksung Cho  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Jong-Won Ha 
Citation
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol.24(2) : 232-240, 2023-01 
Journal Title
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
ISSN
 2047-2404 
Issue Date
2023-01
MeSH
Aortic Valve / diagnostic imaging ; Aortic Valve / surgery ; Aortic Valve Stenosis* / diagnostic imaging ; Aortic Valve Stenosis* / surgery ; Heart Valve Prosthesis* ; Humans ; Prosthesis Design ; Retrospective Studies
Keywords
diagnostic algorithm ; pannus ; prosthetic aortic valve dysfunction ; reference effective orifice area
Abstract
AIMS: We aimed to evaluate the efficacy of the measured effective orifice area (EOA)/reference EOA ratio in discriminating mechanical prosthetic aortic valve (PAV) obstruction. METHODS AND RESULTS: This is a retrospective study of 193 mechanical PAV patients with an elevated mean transprosthetic pressure gradient (PG) over 20 mmHg or peak velocity over 3 m/s. Of those, 143 patients were objectively proven PAV obstruction with cardiac computed tomography or surgical inspection. The EOA was measured using the continuity equation, and the reference EOA values were obtained from previous guidelines. The measured/reference EOA ratio was significantly lower in the obstruction group (0.63 ± 0.18 vs. 0.86 ± 0.17; P < 0.001). The EOA ratio added incremental value for discriminating obstruction from the conventional parameters recommended in the guidelines. Receiver operating characteristic curve analysis revealed that the measured/reference EOA ratio discriminated PAV obstruction from those without obstruction [area under the curve (AUC), 0.840; 95% confidence interval, 0.783-0.898; P < 0.001]. A cutoff of 0.71 had 73.4% sensitivity and 82.0% specificity. The novel diagnostic algorithm adding the EOA ratio had similar accuracy to previous guideline algorithms, including reference EOA, and conventional Doppler parameters (AUC, 0.763 vs. 0.731; P = 0.309). In patients with a large PAV (≥23 mm), the novel algorithm had higher accuracy than the previous algorithm (AUC, 0.788 vs. 0.642; P = 0.019). CONCLUSION: The ratio of measured/reference EOA adds incremental value over conventional Doppler parameters and might be helpful for distinguishing PAV obstruction. © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Full Text
https://academic.oup.com/ehjcimaging/article/24/2/232/6783001
DOI
10.1093/ehjci/jeac206
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyu(김규)
Kim, Dae-Young(김대영)
Suh, Jee Won(서지원) ORCID logo https://orcid.org/0000-0003-0287-0651
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Cho, Ik Sung(조익성)
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/194278
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