Citation: European heart journal cardiovascular Imaging. 2020 Apr 03.Journal: European heart journal cardiovascular Imaging.Published: ; 2020ISSN: 2047-2404.Full author list: Vriesendorp MD; Van Wijngaarden RAFL; Head SJ; Kappetein AP; Hickey GL; Rao V; Weissman NJ; Reardon MJ; Moront MG; Sabik JF; Klautz RJM.UI/PMID: 32243493.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: https://dx.doi.org/10.1093/ehjci/jeaa044 (Click here)Abbreviated citation: Eur Heart J Cardiovasc Imaging. 2020 Apr 03.Abstract: AIMS : Indexed effective orifice area (EOAi) charts are used to determine the likelihood of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR). The aim of this study is to validate whether these EOAi charts, based on echocardiographic normal reference values, can accurately predict PPM.Abstract: METHODS AND RESULTS : In the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial, 986 patients with aortic valve stenosis/regurgitation underwent AVR with an Avalus valve. Patients were randomly split (50:50) into training and test sets. The mean measured EOAs for each valve size from the training set were used to create an Avalus EOAi chart. This chart was subsequently used to predict PPM in the test set and measures of diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) were assessed. PPM was defined by an EOAi <=0.85 cm2/m2, and severe PPM was defined as EOAi <=0.65 cm2/m2. The reference values obtained from the training set ranged from 1.27 cm2 for size 19 mm up to 1.81 cm2 for size 27 mm. The test set had an incidence of 66% of PPM and 24% of severe PPM. The EOAi chart inaccurately predicted PPM in 30% of patients and severe PPM in 22% of patients. For the prediction of PPM, the sensitivity was 87% and the specificity 37%. For the prediction of severe PPM, the sensitivity was 13% and the specificity 98%.Abstract: CONCLUSION : The use of echocardiographic normal reference values for EOAi charts to predict PPM is unreliable due to the large proportion of misclassifications. Copyright (c) The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.