Accuracy of Aortic Annulus Measurements by Three-dimensional Transesophageal Echocardiography and Predictive Value for Thoracic Aorta Aneurysm in Patients with Aortic Regurgitation

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2023 Feb 23

PMID 36819254

Authors

Qinglong Meng

Yuan Chen

Dandan Wang

Jia Tao

Hao Wang

Affiliations

Soon will be listed here.

Abstract

Background: Accurate assessment of the aortic annulus (AA) dimension and judgment of thoracic aorta aneurysm is crucial for patients with aortic regurgitation (AR) before surgery. The aim of this study was to evaluate the accuracy and reproducibility of three-dimensional transesophageal echocardiography (3D-TEE) methods for AA measurement and explore the predictive value of the AA dimensions obtained by 3D-TEE for high-risk thoracic aorta aneurysms using the gold standard of multi-slice computed tomography (MSCT).

Methods: 3D-TEE was performed on 111 patients with pure moderate-to-severe AR, and MSCT examination was conducted simultaneously. AA dimensions were obtained using reconstruction software for these two imaging techniques. Thoracic aortic diameters at standard anatomic landmarks were also measured by MSCT. All patients were divided into two groups depending on the presence of high-risk thoracic aorta aneurysms.

Results: Compared to MSCT, 3D-TEE overestimated all AA parameters. However, no statistically significant differences were found in the average bias between methods (minimum diameter: 26.07±3.57 . 25.88±3.68 mm, P=0.52; maximum diameter: 32.30±2.68 . 31.78±4.06 mm, P=0.11; area: 669.76±155.19 . 660.05±168.28 mm, P=0.44; perimeter: 93.52±10.42 . 92.26±11.71 mm, P=0.12). 3D-TEE demonstrated good correlations with MSCT measurement for AA minimum diameter, maximum diameter, area, and perimeter (r=0.63, 0.64, 0.74, 0.69, P<0.05 for all). According to the multivariate logistic regression analysis, the AA minimum diameter obtained by 3D-TEE was the best predictor for the presence of high-risk thoracic aorta aneurysms. The sensitivity and specificity for prediction were 84.6% and 63.9%, respectively, for an AA minimum diameter ≥25.74 mm (AUC: 0.759, 95% CI: 0.668-0.850).

Conclusions: AA measurements obtained by the 3D-TEE method are feasible and reliable for patients with pure AR. The AA minimum diameter measured by 3D-TEE can effectively predict the presence of high-risk thoracic aorta aneurysms.

Citing Articles

The Z-scores of cardiac indices among healthy children: a systematic review and meta-analysis.

Chinawa J, Chinawa A, Chukwu B, Peter I BMC Cardiovasc Disord. 2024; 24(1):455.

PMID: 39192197 PMC: 11351509. DOI: 10.1186/s12872-024-04104-6.

References

Hakim D, Ghimire G, Alli O, Singh S, Sasse M, Booker O . Large-field intravascular ultrasound for annular sizing and predicting paravalvular regurgitation during TAVR: comparisons with multidetector computed tomography and transoesophageal echocardiography. Eur Heart J Cardiovasc Imaging. 2017; 18(12):1404-1413. DOI: 10.1093/ehjci/jew322. View

Petersen J, Voigtlander L, Schofer N, Neumann N, von Kodolitsch Y, Reichenspurner H . Geometric changes in the aortic valve annulus during the cardiac cycle: impact on aortic valve repair. Eur J Cardiothorac Surg. 2018; 54(3):441-445. DOI: 10.1093/ejcts/ezy099. View

Blanke P, Weir-McCall J, Achenbach S, Delgado V, Hausleiter J, Jilaihawi H . Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI) / transcatheter aortic valve replacement (TAVR): An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2019; 13(1):1-20. DOI: 10.1016/j.jcct.2018.11.008. View

Stella S, Italia L, Geremia G, Rosa I, Ancona F, Marini C . Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection. Eur Heart J Cardiovasc Imaging. 2018; 20(1):45-55. DOI: 10.1093/ehjci/jey013. View

Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min J, Leipsic J . SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr. 2012; 6(6):366-80. DOI: 10.1016/j.jcct.2012.11.002. View

Le Polain De Waroux J, Pouleur A, Goffinet C, Vancraeynest D, Van Dyck M, Robert A . Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation. 2007; 116(11 Suppl):I264-9. DOI: 10.1161/CIRCULATIONAHA.106.680074. View

Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P . Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017; 30(4):303-371. DOI: 10.1016/j.echo.2017.01.007. View

Jilaihawi H, Wu Y, Yang Y, Xu L, Chen M, Wang J . Morphological characteristics of severe aortic stenosis in China: imaging corelab observations from the first Chinese transcatheter aortic valve trial. Catheter Cardiovasc Interv. 2015; 85 Suppl 1:752-61. DOI: 10.1002/ccd.25863. View

DeLong E, Delong D, Clarke-Pearson D . Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44(3):837-45. View

10.

Hiratzka L, Bakris G, Beckman J, Bersin R, Carr V, Casey Jr D . 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice.... J Am Coll Cardiol. 2010; 55(14):e27-e129. DOI: 10.1016/j.jacc.2010.02.015. View

11.

Prihadi E, van Rosendael P, Vollema E, Bax J, Delgado V, Ajmone Marsan N . Feasibility, Accuracy, and Reproducibility of Aortic Annular and Root Sizing for Transcatheter Aortic Valve Replacement Using Novel Automated Three-Dimensional Echocardiographic Software: Comparison with Multi-Detector Row Computed Tomography. J Am Soc Echocardiogr. 2017; 31(4):505-514.e3. DOI: 10.1016/j.echo.2017.10.003. View

12.

Schafers H, Fries R, Langer F, Nikoloudakis N, Graeter T, Grundmann U . Valve-preserving replacement of the ascending aorta: remodeling versus reimplantation. J Thorac Cardiovasc Surg. 1998; 116(6):990-6. DOI: 10.1016/s0022-5223(98)70051-0. View

13.

Sucha D, Tuncay V, Prakken N, Leiner T, van Ooijen P, Oudkerk M . Does the aortic annulus undergo conformational change throughout the cardiac cycle? A systematic review. Eur Heart J Cardiovasc Imaging. 2015; 16(12):1307-17. DOI: 10.1093/ehjci/jev210. View

14.

Khalique O, Hamid N, White J, Bae D, Kodali S, Nazif T . Impact of Methodologic Differences in Three-Dimensional Echocardiographic Measurements of the Aortic Annulus Compared with Computed Tomographic Angiography Before Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr. 2016; 30(4):414-421. DOI: 10.1016/j.echo.2016.10.012. View

15.

Biaggi P, Matthews F, Braun J, Rousson V, Kaufmann P, Jenni R . Gender, age, and body surface area are the major determinants of ascending aorta dimensions in subjects with apparently normal echocardiograms. J Am Soc Echocardiogr. 2009; 22(6):720-5. DOI: 10.1016/j.echo.2009.03.012. View

16.

Queiros S, Morais P, Fehske W, Papachristidis A, Voigt J, Fonseca J . Assessment of aortic valve tract dynamics using automatic tracking of 3D transesophageal echocardiographic images. Int J Cardiovasc Imaging. 2019; 35(5):881-895. DOI: 10.1007/s10554-019-01532-w. View

17.

Quint L, Liu P, Booher A, Watcharotone K, Myles J . Proximal thoracic aortic diameter measurements at CT: repeatability and reproducibility according to measurement method. Int J Cardiovasc Imaging. 2012; 29(2):479-88. PMC: 3529204. DOI: 10.1007/s10554-012-0102-9. View

18.

Neumann N, Petersen J, Sinning C, Sequeira-Gross T, Schofer N, Reichenspurner H . Focus on the annuloplasty in aortic valve repair: implications from a quantitative multislice computed tomography analysis. Quant Imaging Med Surg. 2020; 10(4):853-861. PMC: 7188605. DOI: 10.21037/qims.2020.03.16. View

19.

Singh J, Evans J, Levy D, Larson M, Freed L, FULLER D . Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999; 83(6):897-902. DOI: 10.1016/s0002-9149(98)01064-9. View

20.

Maia J, Ladeiras-Lopes R, Guerreiro C, Carvalho M, Fontes-Carvalho R, Braga P . Accuracy of three-dimensional echocardiography in candidates for transcatheter aortic valve replacement. Int J Cardiovasc Imaging. 2019; 36(2):291-298. DOI: 10.1007/s10554-019-01716-4. View