TY - JOUR
T1 - Aortic valve area calculation using 3D transesophageal echocardiography
T2 - Implications for aortic stenosis severity grading
AU - Beneduce, Alessandro
AU - Capogrosso, Cristina
AU - Moroni, Francesco
AU - Ancona, Francesco
AU - Falasconi, Giulio
AU - Pannone, Luigi
AU - Stella, Stefano
AU - Ingallina, Giacomo
AU - Melillo, Francesco
AU - Ancona, Marco Bruno
AU - Romano RT, Vittorio
AU - Palmisano, Anna
AU - Latib, Azeem
AU - Colombo, Antonio
AU - Montorfano, Matteo
AU - Esposito, Antonio
AU - Agricola, Eustachio
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2020/12
Y1 - 2020/12
N2 - Aims: Aortic stenosis (AS) grading by 2D-transthoracic echocardiography (2D-TTE) aortic valve area (AVA) calculation is limited by left ventricular outflow tract (LVOT) area underestimation. The combination of Doppler parameters with 3D LVOT area obtained by multidetector computed tomography (MDCT) can improve AS grading, reconciling discordant 2D-TTE findings. This study aimed to systematically evaluate the role of 3D-transesophageal echocardiography (3D-TEE) in AS grading using MDCT as reference standard. Methods and results: 288 patients (81 ± 6.3 years, 52.4% female) with symptomatic AS underwent 2D-TTE, 3D-TEE, and MDCT for transcatheter aortic valve implantation. Doppler parameters were combined with 3D LVOT areas measured by manual and semi-automated software 3D-TEE and by MDCT to calculate AVA, reassessing AS severity. Both 3D-TEE modalities demonstrated good correlation with MDCT, with excellent intra-observer and inter-observer variability. Compared to MDCT, 3D-TEE measurements significantly underestimated AVA (PANOVA <.0001), although the difference was clinically acceptable. Compared to 2D-TTE, 3D-TEE manual and semi-automated software reclassified severe AS in 21.9% and 25.2% of cases, respectively (P <.0001), overcame grading parameters discordance in more than 40% of cases in patients with low-gradient AS (P <.0001) and reduced the proportion of low-flow states in nearly 75% of cases when combined to stroke volume index assessment (P <.0001). 3D-TEE imaging modalities showed a reduction in the proportion of patients with low-gradient and pathological AVA as defined by 2D-TTE, and improved AVA and mean pressure gradient agreement with current guidelines cutoff values. Conclusion: 3D-TEE AVA calculation is a reliable tool for AS grading with excellent reproducibility and good correlation with MDCT measurements.
AB - Aims: Aortic stenosis (AS) grading by 2D-transthoracic echocardiography (2D-TTE) aortic valve area (AVA) calculation is limited by left ventricular outflow tract (LVOT) area underestimation. The combination of Doppler parameters with 3D LVOT area obtained by multidetector computed tomography (MDCT) can improve AS grading, reconciling discordant 2D-TTE findings. This study aimed to systematically evaluate the role of 3D-transesophageal echocardiography (3D-TEE) in AS grading using MDCT as reference standard. Methods and results: 288 patients (81 ± 6.3 years, 52.4% female) with symptomatic AS underwent 2D-TTE, 3D-TEE, and MDCT for transcatheter aortic valve implantation. Doppler parameters were combined with 3D LVOT areas measured by manual and semi-automated software 3D-TEE and by MDCT to calculate AVA, reassessing AS severity. Both 3D-TEE modalities demonstrated good correlation with MDCT, with excellent intra-observer and inter-observer variability. Compared to MDCT, 3D-TEE measurements significantly underestimated AVA (PANOVA <.0001), although the difference was clinically acceptable. Compared to 2D-TTE, 3D-TEE manual and semi-automated software reclassified severe AS in 21.9% and 25.2% of cases, respectively (P <.0001), overcame grading parameters discordance in more than 40% of cases in patients with low-gradient AS (P <.0001) and reduced the proportion of low-flow states in nearly 75% of cases when combined to stroke volume index assessment (P <.0001). 3D-TEE imaging modalities showed a reduction in the proportion of patients with low-gradient and pathological AVA as defined by 2D-TTE, and improved AVA and mean pressure gradient agreement with current guidelines cutoff values. Conclusion: 3D-TEE AVA calculation is a reliable tool for AS grading with excellent reproducibility and good correlation with MDCT measurements.
KW - 3D transesophageal echocardiography
KW - aortic stenosis
KW - multidetector computed tomography
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U2 - 10.1111/echo.14883
DO - 10.1111/echo.14883
M3 - Article
C2 - 33026122
AN - SCOPUS:85092161884
SN - 0742-2822
VL - 37
SP - 2071
EP - 2081
JO - Echocardiography
JF - Echocardiography
IS - 12
ER -