Abstract: Objective To evaluate the value of automatic analysis software(ValvePlus)before transcatheter aortic valve replacement(TAVR), discuss the correlation and consistency between ValvePlus and manual measurement, assess the influence of different degrees of valve calcification on measurement outcomes, and compare the time between the two and the accuracy of recommended valve sizes. Methods Clinical and imaging data from 138 patients with aortic stenosis who underwent aorta computed tomography angiography(CTA)were retrospectively collected. The area, circumference, maximum diameter, and minimum diameter of the aortic annulus, distance to the left and right coronary arteries, maximum diameter and minimum diameter of the ascending aorta, left ventricular outflow tract, sinotubular junction, and distance from the coronary sinus to the contralateral commissure were measured by manual method and automatic software, and the measurement time was recorded. Pearsons correlation coefficient(r)and intraclass correlation coefficient(ICC)were used to compare correlation and consistency, and Bland-Altman was plotted to further analyze the differences. The patients were categorized based on the extent of valve calcification, and the correlation and consistency among the different subgroups were compared, and a paired t-test was used to compare the time of measurements. The Kappa test was used to evaluate the consistency between the valve size recommended by the two methods and the actual valve size. Results Among the 138 patients, 93 were male, with a mean age of 64 years. All patients presented tricuspid aortic valves and 80.4% exhibited mild or higher aortic regurgitation. Automatic measurement was in good correlation and consistency with manual measurement, with the r values of 0.844-0.990 and the ICC values of 0.841-0.988, and the r and ICC values of the area of aortic annulus were the highest, respectively 0.990 and 0.988. A total of 96 patients exhibited moderate to severe cardiac valve calcification, and there was a high correlation and consistency between manual and automatic measurements in different subgroups, with both the r and ICC values exceeding 0.8. Automated measurement significantly shortened measurement time ［3 min(29±24)s vs. 8 min(14±36)s, P<0.001］. The Kappa value between the recommended valve size based on automatic measurement of the annulus area, circumference, and average diameter and the actual valve type was 0.886, 0.765, and 0.761, respectively. Conclusion The ValvePlus provides reliable information on anatomical parameters of the aortic root before TAVR, demonstrating high correlation and consistency with manual measurements in various calcification subgroups, while significantly reducing the time required for measurements, and the recommended valve size based on automatic measurement is accurate, which can help the TAVR team make accurate assessments and guide valve size selection.

Key words: Transcatheter aortic valve replacement, Aortic stenosis, Aortic annulus, CT angiography