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Objectives: In transcatheter aortic valve implantation (TAVI), assessment of the aortic annulus is mandatory. We sought to investigate the correlation between trans-oesophageal echocardiography (TEE) and multi-detector computed tomography (MDCT) for annulus diameter assessment before TAVI.Methods: A total of 122 patients (67 male, mean age 84 ± 6 years) underwent MDCT and TEE for TAVI planning. In TEE annulus diameters were obtained in a long-axis view at diastole. MDCT data were evaluated using MPR images, and corresponding projections were adjusted for MDCT and TEE. Patients were classified by the predominant localisation of aortic valve calcifications, and annulus diameters between TEE and MDCT were correlated. Additionally, the eccentricity of the aortic annulus was calculated.Results: Mean eccentricity of the aortic annulus determined by MDCT was 0.34 ± 0.17, with no difference according to valve calcification. Regarding the aortic annulus diameter, the mean values measured were 24.3 ± 2.1 mm in MDCT and 24.0 ± 2.5 mm in TEE (P < 0.0001 for agreement).Conclusions: Independent of the pattern of aortic valve calcification, close correlation is found between CT and TEE measurements of the aortic annulus diameter. In addition, CT demonstrates the non-circular shape of the aortic annulus.Key Points: Accurate assessment of aortic annulus before transcatheter aortic valve implantation is crucial. Trans-oesophageal echocardiography has been the preferred method for aortic annulus assessment. We demonstrated a strong correlation between TEE and CT for annulus dimensions. CT reliably demonstrates the non-circular shape of the aortic annulus. CT could therefore be generally used for aortic annulus assessment before TAVI. [ABSTRACT FROM AUTHOR]

Objectives: Aortic valve calcification (AVC) determined by computed tomography has emerged as a complementary measure of aortic stenosis (AS) severity and as a predictor of adverse events. Thus, AVC can guide further treatment decisions in patients with low-gradient AS (LG-AS). We compared the symptomatic and prognostic outcome of patients with low vs. high AVC after transcatheter aortic valve implantation (TAVI)., Methods: Patients with an aortic valve area index ≤ 0.6 cm 2 /m 2 and a mean pressure gradient (MPG) < 40 mmHg were classified as low-flow, low-gradient AS (LFLG-AS; stroke volume index [SVI] ≤ 35 ml/m 2 , left ventricular ejection fraction [LVEF] < 50%, n = 173), paradoxical LFLG-AS (pLFLG-AS, SVI ≤ 35 ml/m 2 , LVEF ≥ 50%, n = 233), or normal-flow, low-gradient AS (NFLG-AS, SVI > 35 ml/m 2 , LVEF ≥ 50%, n = 244); patients with MPG ≥ 40 mmHg (n = 1142) served as controls. Patients were further categorized according to published AVC thresholds., Results: Demographic characteristics and cardiovascular risk were not different between patients with high vs. low AVC in any of the subgroups. Patients with low AVC had a lower MPG. Symptom improvement at 30 days was observed in the majority of patients but was less pronounced in LFLG-AS patients with low vs. those with high AVC. Kaplan-Meier 1-year survival curves were identical between patients with low and high AVC in all three LG-AS groups., Conclusions: The severity of LG-AS based on AVC has no impact on 1-year prognosis once TAVI has been performed., Key Points: • Aortic valve calcification (AVC) determined by computed tomography has emerged as a complementary measure of aortic stenosis (AS) severity and is of prognostic value in selected patients. • Patients with inconsistent echocardiographic measures can be classified as having severe or nonsevere AS by the computed tomography-derived AVC score. • The prognostic value of AVC in patients with low-gradient AS is abrogated after correction of afterload by TAVI.

Objectives: The aim of this study was to assess septal and right ventricular insertion point (RVIP) fibrosis in patients with chronic thromboembolic pulmonary hypertension (CTEPH) via native T1 mapping and extracellular volume fraction (ECV) determination and to analyze correlations with functional parameters., Methods: Imaging was performed at 1.5 Tesla in 24 patients diagnosed with CTEPH and 24 controls. T1 values were measured within the septal myocardium, the upper and lower RVIP, and the lateral wall at basal short axis section., Results: The mean septal native T1 values were 1012.8 ms ± 50.5 in the CTEPH group and 956.9 ms ± 24.4 in controls (p < 0.001), upper RIVP 1050.8 ms ± 64.2 vs. 965.3 ms ± 37.1 (p < 0.001), and lower RVIP 1084.4 ms ± 93.1 vs. 959.8 ms ± 40.4 (p < 0.001). The corresponding mean ECV values were also significantly increased in the CTEPH group (p < 0.001). Native septal T1 showed a strong negative correlation with right ventricular ejection fraction (k = -0.92; p = 0.01)., Conclusions: We conclude that native T1 mapping and ECV assessment enable visualization and quantification of septal fibrosis in CTEPH patients. The results also correlate well with right ventricular ejection fraction. Therefore, these parameters might be useful for prognosis and as therapy-monitoring tool in the future., Key Points: • Septal native T1 and ECV values are significantly higher in CTEPH patients. • Native T1 and ECV values are elevated even in absence of LGE. • These techniques therefore enable an improved quantification of septal fibrosis in CTEPH. • Native T1 values also correlate well with right ventricular EF and PA-pressure. • Prognosis and therapy-monitoring might be assessable in the future with these parameters.