International journal of cardiology · 2026
Comparative assessment of 4D CT-derived geometric and effective orifice areas in severe aortic stenosis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Kai Takahiko, Ajiro Daiki, Yoshida Toshiya, Sekiguchi Masahiro, Kobayashi Yoshikuni, Tanaka Tetsu, Saito Ami, Shoji Tatsuro, Oda Ryutaro, Miyahara Daisuke, Harashima Yuki, Shiokawa Noriko, Okuno Taishi, Sato Yukio, Kuwata Shingo, Ogawa Yasuyoshi, Sakamoto Miki, Izumo Masaki, Akashi Yoshihiro J
Аннотация
BACKGROUND: The geometric orifice area (GOA) measured by four-dimensional computed tomography (4D-CT) offers a flow-independent anatomical assessment of aortic stenosis (AS). However, its quantitative relationships with effective orifice areas (EOA) from echocardiography and catheterization, as well as the hemodynamic factors underlying their relationship and their relevance to markers of left-ventricular load, remain insufficiently defined.
METHODS: GOA was obtained at individualized peak systole by CT planimetry, and EOAecho and EOAcathe were calculated using the continuity and Gorlin equations. Associations, agreement, and bias between GOA and each EOA were evaluated using correlation analysis, Passing-Bablok regression, and Bland-Altman plots. Multivariable regression identified hemodynamic determinants of EOA-to-GOA ratios. Hierarchical regression assessed the incremental explanatory value of valve area indices for preprocedural NT-proBNP.
RESULTS: GOA demonstrated excellent reproducibility (intraclass correlation coefficient 0.95). GOA correlated strongly with EOAecho (r = 0.67) and EOAcathe (r = 0.65), whereas the correlation between EOAecho and EOAcathe was moderate (r = 0.55). Passing-Bablok analysis revealed proportional bias for both modalities. Stroke volume index significantly increased both EOAecho-to-GOA and EOAcathe-to-GOA ratios. Only GOA provided a statistically significant but modest incremental explanatory value for preprocedural NT-proBNP (ΔR2 = 0.03; p = 0.02), whereas neither EOAecho nor EOAcathe significantly improved model performance.
CONCLUSIONS: CT-derived GOA is a highly reproducible, flow-independent anatomical metric that correlates strongly with physiological valve areas while offering additional clinical insight. Variability in EOA-to-GOA scaling underscores the complementary roles of anatomical and functional assessments in characterizing AS severity.
METHODS: GOA was obtained at individualized peak systole by CT planimetry, and EOAecho and EOAcathe were calculated using the continuity and Gorlin equations. Associations, agreement, and bias between GOA and each EOA were evaluated using correlation analysis, Passing-Bablok regression, and Bland-Altman plots. Multivariable regression identified hemodynamic determinants of EOA-to-GOA ratios. Hierarchical regression assessed the incremental explanatory value of valve area indices for preprocedural NT-proBNP.
RESULTS: GOA demonstrated excellent reproducibility (intraclass correlation coefficient 0.95). GOA correlated strongly with EOAecho (r = 0.67) and EOAcathe (r = 0.65), whereas the correlation between EOAecho and EOAcathe was moderate (r = 0.55). Passing-Bablok analysis revealed proportional bias for both modalities. Stroke volume index significantly increased both EOAecho-to-GOA and EOAcathe-to-GOA ratios. Only GOA provided a statistically significant but modest incremental explanatory value for preprocedural NT-proBNP (ΔR2 = 0.03; p = 0.02), whereas neither EOAecho nor EOAcathe significantly improved model performance.
CONCLUSIONS: CT-derived GOA is a highly reproducible, flow-independent anatomical metric that correlates strongly with physiological valve areas while offering additional clinical insight. Variability in EOA-to-GOA scaling underscores the complementary roles of anatomical and functional assessments in characterizing AS severity.