TAVR Planning: 3D Transesophageal Echocardiography vs Multidetector CT

transesophageal echocardiography for open heart surgery
transesophageal echocardiography for open heart surgery
Three-dimensional transesophageal echocardiography does not require contrast media, which may be particularly beneficial in patients with impaired renal function.

Three‐dimensional transesophageal echocardiography (3D TEE) has demonstrated similar results to multidetector computed tomography (MDCT) in planning for transcatheter aortic valve replacement, according to study results published in the Journal of the American Heart Association. Because it does not require a contrast exposure, 3D TEE may be advantageous for those with renal dysfunction.

This systematic review and meta-analysis included 1599 individuals from 19 randomized trials, all of which compared different imaging techniques for performing aortic valve measurements. The correlation coefficient between annular area measurements obtained by MDCT and 3D TEE imaging techniques constituted the primary outcome of the study. Secondary outcomes included correlation coefficients for left ventricular outflow tract area, annular perimeter, and annular diameter, mean differences between the 2 types of measurements, and interobserver/intraobserver agreements. Study heterogeneity was assessed using the I² test and Cochran Q statistic, while leave-one-out sensitivity analysis was performed for the primary outcome.

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For 3D TEE vs MDCT imaging techniques, strong associations were identified for annular area (correlation coefficient, 0.86; 95% CI, 0.80-0.90), annular diameter (0.80; 95% CI, 0.70-0.87), annular perimeter (0.89; 95% CI, 0.82-0.93), and left ventricular outflow tract area (0.78; 95% CI, 0.61-0.88).

No significant mean differences between measurements were observed (annular area, -0.12 cm²; annular perimeter, -0.02 cm; mean annular diameter, -0.03 cm). Both 3D TEE and MDCT showed good discriminatory abilities for paravalvular aortic regurgitation, as well as good intra- and interobserver agreement. Meta-regression showed mean body mass, transaortic gradient, and body surface area to correlate with weaker associations between 3D TEE and MDCT annular area measurements.

Study limitations included high statistical heterogeneity among the majority of outcomes, the use of automated calculation of annular area in certain studies, and some interstudy heterogeneity.

The study researchers concluded that “3D TEE is comparable to MDCT for [transcatheter aortic valve replacement] planning.” As contrast media is not required for 3D TEE, they add that “it may be advantageous in patients with preexisting renal dysfunction.”  

Disclosure: This study was in part funded by Edwards Lifesciences and Medtronic. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Rong LQ, Hameed I, Salemi A, et al. Three‐dimensional echocardiography for transcatheter aortic valve replacement sizing: a systematic review and meta‐analysis. J Am Heart Assoc. 2019;8(19):e013463.