Abstract
Ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. However, there is no uniformity among experts regarding ascending aorta diameter quantification by echocardiography. The aim of this study was to compare maximum aortic root and ascending aorta diameters determined by the diastolic leading edge (DLE) and the systolic inner edge (SIE) conventions in adult and pediatric patients with inherited cardiovascular diseases. Transthoracic echocardiograms were performed in 328 consecutive patients (260 adults and 68 children). Aorta diameters were measured twice at the root and ascending aorta by the DLE convention following the 2015 American Society of Echocardiography (ASE) adult guidelines and the SIE convention following the 2010 ASE pediatric guidelines. Comparison of the diameters measured by the two conventions in the overall population showed a non-significant underestimation of the diameter measured by the SIE convention at root level of 0.28 mm (CI −1.36; 1.93) and at tubular ascending aorta level of 0.17 mm (CI −1.69; 2.03). Intraobserver and interobserver variability were excellent. Maximum aorta diameter measured by the leading edge convention in end-diastole and the inner edge convention in mid-systole had similar values to a mild non-significant underestimation of the inner-to-inner method that permits them to be interchangeable when used in clinical practice.
Highlights
Maximum aortic root and ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases
Intraobserver variability was good by diastole by the leading-to-leading edge convention (DLE) (ICC 0.97–95% CI 0.95–0.99) and systolic inner edge (SIE) (0.89 95% CI 0.82–0.97) at the level of the aortic root and ascending aorta (ICC 0.94–95% CI 0.89– 0.99) and (ICC 0.87–95% CI 0.77–0.96), respectively
The present study showed maximum aorta diameter measured following pediatric [4] and adult American Society of Echocardiography (ASE) [3] guidelines recommendations to be similar with a mild non-significant underestimation of the SIE method compared with DLE, which allows them to be interchangeable when used in clinical practice
Summary
Maximum aortic root and ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. Accurate and standardized reproducible measurement techniques are required [1,2]. Transthoracic echocardiography (TTE) is the most widely used imaging technique in clinical practice given its availability, accuracy, and low cost. There is no consensus among experts regarding the method used to take ascending aorta measurements by echocardiography. The American Society of Echocardiography (ASE) guidelines recommended that two-dimensional echocardiographic measurements be performed in the parasternal longaxis view, adult guidelines in 2015 recommended this measurement at end-diastole by the leading-to-leading edge convention (DLE) [3], while the pediatric guidelines recommended the inner-to-inner edge convention in mid-systole (SIE) [4]. The inner-to-inner edge (I-I) convention by echocardiography was supported by the 2010 American College of Cardiology and American Heart Association guidelines [5]
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