Influence of left ventricular geometry and function on aortic annular dimensions as assessed with multi-detector row computed tomography: implications for transcatheter aortic valve implantation.

ABSTRACT

AIMS: Evaluate changes in aortic annular dimensions in relation to severe aortic stenosis (AS) and left ventricular (LV) dysfunction. METHODS AND RESULTS: Mean aortic annular diameters and geometries were compared between 90 severe AS patients and 111 controls by multi-detector row computed tomography (MDCT). All severe AS patients were also dichotomized into two groups based on the presence of preserved (≥ 50%) or impaired (<50%) LV ejection fraction (EF). The influence of LV geometry and function on changes in aortic annular dimensions was examined. Patients with severe AS had similar aortic annular dimensions and geometries compared with controls even after correcting for baseline differences in age and body surface area (BSA). However, severe AS patients with LV dysfunction (LVEF <50%) had significantly larger mean aortic annular diameter (26.4 ± 1.9 vs. 24.5 ± 2.1 mm, P < 0.001) compared with patients with preserved LVEF. The presence of LV dysfunction, male gender, and larger BSA were independent determinants of a larger aortic annulus on MDCT. CONCLUSION: In severe AS patients, the presence of LV dysfunction, not the presence of severe AS, was an independent determinant of a larger aortic annular diameter.