Comparative assessment of ascending aorta diameter using three-dimensional trans-thoracic echocardiography vs. ECG-gated computerized tomographic angiography.

Abstract

Currently, 2D TTE is used in routine practice for the follow-up of ascending aorta aneurism (AAA). When the maximal aortic diameter reaches the surgical threshold, ECG-gated computerized tomographic angiography (CT) is used to confirm the diameter. No study has evaluated ascending aortic diameter measurement with 3D trans-thoracic echocardiography (3DTTE). The aim of this study was to compare 3DTTE with CT for assessment of the aortic root diameters. Standard 2D-TTE, followed with a 3D volume acquisition (3DTTE), and CT were performed in patients seen in our clinic for an AAA. After a double oblique reconstruction, measurements were obtained, using the inner-to-inner technique in end-diastole in a strict transverse plane passing through the maximal diameter ‘cusp to cusp’ for each cusp in 3D-TTE and CT. CT and TTE were performed within 3 months. Transverse plan of the sinus of Valsalva was used in 2DTTE, 3DTTE and CT to measure: diameters between non-coronary and right coronary sinuses (2DNR, 3DNR and CTNR), between left and right coronary sinuses (2DLR, 3DLR, CTLR), and between left and non-coronary sinuses (2DLN 3DLN, CTLN). Correlation between diameters was evaluated by Bland–Altmann diagrams and Spearman's correlation coefficient. Forty-four consecutive patients with ascending aortic aneurysm were included (49 +/ − 15 years, men 77%). Diameters between CT and 2DTTE were statistically different except for the NR diameter (mean differences: CTNR-2DNR = 0.02 mm, P = 0.48, CTLR-2DLR = −2.1 mm, P = 0.0003, CTLN-2DLN = − 2.1 mm, P = 0.01). Diameters between MDCT and 3DTTE were similar (mean differences: CTNR −3DNR = 0 mm, P = 0.3, CTLR-3DLR = 0.1 mm, P = 0.3, CTLN − 3DLN = −0.2 mm, P = 0.4). In addition, MDCT and 3DTTE diameters showed a good correlation (rNR = 0.95, rLR = 0.94 rLN = 0.91) ( Fig. 1 ). Aortic root diameters obtained with 3DTTE are highly correlated with CT diameters. 3D TTE may be an additional follow-up technique in patients with aortic root aneurysms.