Aortic valve annulus diameter in Chinese patients with severe calcific aortic valve stenosis: implications for transcatheter aortic valve implantation.

OBJECTIVES: The objective of the study was to describe the distribution and determine the predictors of aortic valve annulus diameter (AVAD) in Chinese patients with severe calcific aortic valve stenosis (CAS).

BACKGROUND: AVAD in Chinese patients with CAS has not been reported. Predictors of AVAD in patients with CAS are unclear.

METHODS: One hundred elderly patients (≥60 years) with severe CAS were included in the study. AVAD in all patients was measured by transthoracic echocardiograph (AVAD-TTE) and in 74 patients of them was measured intra-operatively (AVAD-intra).

RESULTS: The intraclass correlation coefficient (ICC) between AVAD-TTE and AVAD-intra was 0.81 (95% CI: 0.72-0.88). The differences between AVAD-TTE and AVAD-intra ranged from -3 to 3 mm and were ≤≤ 2mm in 91.9% (68/74) of patients. The intra-observer ICC for TTE was 0.87 (95% CI: 0.74-0.94). Mean AVAD in the whole population was 21.80 ± 2.09 (17-27) mm. 11% of cases had an AVAD < 20 mm, 78% had an AVAD between 20 and 24 mm, and 11% had an AVAD between 25 and 27 mm. The correlation between AVAD and height (r = 0.476, P < 0.001) was stronger than that between AVAD and weight (r = 0.215, P = 0.034) or body surface area (BSA) (r = 0.358, P < 0.001). Multivariate regression showed that height, sex, and age but not BSA were independent predictors of AVAD (all P < 0.05).

CONCLUSION: Most of Chinese patients with CAS can be candidates for transcatheter aortic valve implantation procedure in terms of AVAD, whereas more sizes of prosthetic valves need to be developed. Sex, age, and especially height, but not BAS, are independent predictors of AVAD in patients with CAS.