Detection of Mechanical Prosthetic Valve Dysfunction. Journal Article

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Authors: Muratori, M; Fusini, L; Ghulam Ali, S; Teruzzi, G; Corrieri, N; Gripari, P; Mapelli, M; Annoni, A; Tamborini, G; Rabbat, MG; Pontone, G; Alamanni, F; Montorsi, P; Pepi, M
Article Title: Detection of Mechanical Prosthetic Valve Dysfunction.
Abstract: The long-term outcome of mechanical aortic and mitral prosthetic valve (A-PV, M-PV) dysfunction (PVD) remains a serious complication associated with high morbidity and mortality. We sought to evaluate the incremental diagnostic value of combined transthoracic echocardiography (TTE) and fluoroscopy (F) in patients with suspected PVD. A total of 354 patients (178 A-PV, 176 M-PV) were imaged by TTE and F within 5 days of hospital admission. PVD was confirmed by transesophageal echocardiography, computed tomography, effective thrombolysis, or surgical inspection. PVD was confirmed in 101 patients (57%) with M-PV and 99 (55%) with A-PV. Regardless of the mechanism of PVD, TTE shows good sensitivity and specificity, with accuracy of 80% for M-PV and 91% for A-PV. F shows high specificity, but low sensitivity with accuracy of 68% for M-PV and 78% for A-PV. The integration of TTE?+?F significantly improved accuracy both for M-PV (83%) and A-PV (96%). At ROC analysis, the combined model of TTE?+?F showed the highest area under the curve for the detection of PVD compared with TTE and F alone (p 0.001). In conclusion, in patients with a clinical suspicion of PVD, the combined model of TTE?+?F offers incremental value over TTE or F alone. This multimodality imaging approach overcomes limitations of TTE or F alone and provides prompt identification of patients who may require further imaging assessment and/or closer follow up.
Journal Title: The American Journal of Cardiology
ISSN: 1879-1913; 0002-9149
Publisher: Unknown  
Date Published: 2021