Abstract
Background3D transesophageal echocardiography (TEE) is superior to 2D TEE in quantitative anatomic evaluation of the mitral valve (MV) but it shows limitations regarding automatic quantification. Here, we tested the inter-/intra-observer reproducibility of a novel full-automated software in the evaluation of MV anatomy compared to manual 3D assessment.MethodsThirty-six out of 61 screened patients referred to our Cardiac Imaging Unit for TEE were retrospectively included. 3D TEE analysis was performed both manually and with the automated software by two independent operators. Mitral annular area, intercommissural distance, anterior leaflet length and posterior leaflet length were assessed.ResultsA significant correlation between both methods was found for all variables: intercommissural diameter (r = 0.84, p < 0.01), mitral annular area (r = 0.94, p > 0, 01), anterior leaflet length (r = 0.83, p < 0.01) and posterior leaflet length (r = 0.67, p < 0.01). Interobserver variability assessed by the intraclass correlation coefficient was superior for the automatic software: intercommisural distance 0.997 vs. 0.76; mitral annular area 0.957 vs. 0.858; anterior leaflet length 0.963 vs. 0.734 and posterior leaflet length 0.936 vs. 0.838. Intraobserver variability was good for both methods with a better level of agreement with the automatic software.ConclusionsThe novel 3D automated software is reproducible in MV anatomy assessment. The incorporation of this new tool in clinical MV assessment may improve patient selection and outcomes for MV interventions as well as patient diagnosis and prognosis stratification. Yet, high-quality 3D images are indispensable.
Highlights
3D transesophageal echocardiography (TEE) is superior to 2D TEE in quantitative anatomic evaluation of the mitral valve (MV) but it shows limitations regarding automatic quantification
Over the last 5 decades, Echocardiography has evolved from mono-dimensional and two-dimensional (2D) imaging to sophisticated 3-dimensional (3D) techniques, introducing a new era for cardiovascular imaging [4]. 2D echocardiographic transesophageal approach increases diagnostic accuracy; the complex anatomy of the so-called MV apparatus remains in many cases still a challenge. 3D transesophageal echocardiography (TEE) has proved to overcome some of the 2D echocardiographic limitations in MV assessment, providing more accurate geometric information of the MV than 2D TEE [5, 6]
Several studies have shown the superiority of 3D TEE in the evaluation of the MV normal and pathologic morphology, Aquila et al Cardiovascular Ultrasound (2016) 14:17 quantification of mitral regurgitation or stenosis [7,8,9,10,11,12] and comprehensive evaluation of MV prolapse before surgery [13, 14]
Summary
3D transesophageal echocardiography (TEE) is superior to 2D TEE in quantitative anatomic evaluation of the mitral valve (MV) but it shows limitations regarding automatic quantification. We tested the inter-/intra-observer reproducibility of a novel full-automated software in the evaluation of MV anatomy compared to manual 3D assessment. The image post-processing is time consuming, with low inter- and intra-observer reproducibility of manual measurements in many cases. The latter has created the need to develop automatic software able to both reduce image analysis time and increase reproducibility. Available computational geometric and biomechanical software require the user’s identification of MV structures as well as manual tracing, being time consuming and limiting reproducibility [15,16,17,18]
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