3D Planimetry Research Articles

Echocardiographic assessment of left ventricular volumes: a comparison of different methods in athletes.

Cardiac magnetic resonance imaging (cMRI) is considered the gold standard for the assessment of left ventricular (LV) systolic function. However, discrepancies have been reported in the literature between LV volumes assessed by transthoracic echocardiography (TTE) and cMRI. The objective of this study was to analyze the differences in LV volumes between different echocardiographic techniques and cMRI. In 64 male athletes (21.1 ± 4.9years), LV volumes were measured by TTE using the following methods: Doppler echocardiography, anatomical M-Mode, biplane/triplane planimetry and 3D volumetry. In addition, LV end-diastolic (LVEDV), end-systolic (LVESV), and stroke volumes (LVSV) were assessed in 11 athletes by both TTE and cMRI. There was no significant difference between LVEDV and LVESV determined by biplane/triplane planimetry and 3D volumetry. LVEDV and LVESV measured by M-Mode were significantly lower compared to 3D volumetry. LVSV determined by Doppler with 3D planimetry of LV outflow tract was significantly higher than 2D planimetry and 3D volumetry, whereas none of the planimetric or volumetric methods for determining LVSV differed significantly. There were no significant differences for LVEDV, LVESV, LVSV and LVEF between cMRI and TTE determined by biplane planimetry in the subgroup of 11 athletes. The choice of echocardiographic method used has an impact on LVSV in athletes, so the LVSV should always be checked for plausibility. The same echocardiographic method should be used to assess LVSV at follow-ups to ensure good comparability. The data suggest that biplane LV planimetry by TTE is not inferior to cMRI.

Impact of Net Atrioventricular Compliance on Mitral Valve Area Assessment-A Perspective Considering Three-Dimensional Mitral Valve Area by Transesophageal Echocardiography.

Net atrioventricular compliance (Cn) can affect the accuracy of mitral valve area (MVA) assessment. We assessed how different methods of MVA assessment are affected by Cn, and if patients with abnormal Cn may be identified by clinical and/or echocardiographic parameters. We studied 244 patients with rheumatic MS. The concordance between mitral valve area (MVA) by 2D planimetry, pressure half-time (PHT), continuity equation (CE), Yeo's index, and 3-dimensional mitral valve area assessed by transesophageal echocardiography (TEE 3DMVA) in patients with normal and abnormal Cn (Cn ≤ 4 mL/mmHg) were evaluated in the 110 patients with both transesophageal echocardiogram (TEE) and transthoracic echocardiogram (TTE). Variables that were associated with abnormal Cn were validated in the remaining 134 patients with only TTE. Except for MVA by CE, concordance with TEE 3DMVA was poorer for all other methods of MVA assessment in patients with abnormal Cn. But, the difference in concordance was only statistically significant for MVA by PHT. Patients with MVA ≤ 1.5 cm2 by 2D planimetry and PHT ≤ 130 ms were likely to have an abnormal Cn. (specificity 98.5%). This finding was validated in the remaining 134 patients (specificity 93%). MVA assessment by PHT is significantly affected by Cn. Abnormal Cn should be suspected when 2D planimetry MVA is ≤1.5 cm2 together with an inappropriately short PHT that is ≤130 ms. In this scenario, MVA by PHT is inaccurate.

Combining 2D Planimetry and Yeo's Index Can Help Accurately Identify Patients with Severe Rheumatic Mitral Stenosis-A Perspective from a 3D Assessment Using Transoesophageal Echocardiography.

Yeo's index is a novel measure of the severity of rheumatic mitral valve stenosis (MS). It is derived from the product of the mitral leaflet separation index and dimensionless index. This study aims to validate Yeo's index using a transesophageal echocardiogram (TEE) three-dimensional (3D) mitral valve area (MVA) as a comparator and to compare the concordance of existing echocardiographic measures of the MVA with TEE 3DMVA. We studied 111 patients with rheumatic MS who underwent both transthoracic echocardiography (TTE) and a TEE assessment of MS severity. Yeo's index, the MVA determined by 2D planimetry, pressure half-time (PHT) and continuity equation (CE) measured on TTE were compared with the TEE 3DMVA. With a linear correlation, Yeo's index showed the best correlation with TEE 3DMVA (r2 = 0.775), followed by 2D planimetry (r2 = 0.687), CE (r2 = 0.598) and PHT (r2 = 0.363). Using TEE 3DMVA as comparator, Yeo's index (ρc = 0.739) demonstrated the best concordance, followed by 2D planimetry (ρc = 0.632), CE (ρc = 0.464) and PHT (ρc = 0.366). When both Yeo's index and 2D planimetry suggested significant MS, the positive predictive value was high (an AUC of 0.966 and a PPV of 100.00% for severe MS, and an AUC of 0.864 and a PPV of 85.71% for very severe MS). When both measures suggested the absence of significant MS, the negative predictive value was also high (an AUC of 0.940 and an NPV of 88.90% for severe MS, and an AUC of 0.831 and an NPV of 88.71% for very severe MS). Yeo's index performed well in identifying severe MS when compared with TEE 3DMVA and may be a useful adjunct to existing methods of measuring MS severity. Combining it with 2D planimetry could further enhance its accuracy.

Superiority of 3D planimetry over pressure half-time method for the assessment of mitral valve area after percutaneous edge-to-edge mitral repair

Introduction and objectivesThere is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient. MethodsA registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient. ResultsWe analyzed data from 167 patients. The mean age was 76±10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89±0.60 cm2 using pressure half-time (PHT), 2.87±0.83 cm2 using 3D planimetry, and the mean gradient was 3±1.19mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (r=0.46, P<.001) than MVA obtained by PHT (r=0.19, P=.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively). ConclusionsOur study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.

Superioridad de la planimetría 3D sobre el tiempo de hemipresión para evaluar el área valvular mitral tras la reparación mitral percutánea de borde a borde

Introduction and objectivesThere is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient. MethodsA registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient. ResultsWe analyzed data from 167 patients. The mean age was 76±10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89±0.60 cm2 using pressure half-time (PHT), 2.87±0.83 cm2 using 3D planimetry, and the mean gradient was 3±1.19mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (r=0.46, P<.001) than MVA obtained by PHT (r=0.19, P=.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively). ConclusionsOur study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.

Long-Term Impact of Small Mitral Valve Orifice Area after Transcatheter Edge-to-Edge Mitral Valve Repair on Clinical Outcome: A Three-Dimensional Echocardiography Study

Iatrogenic mitral stenosis is a complication associated with transcatheter edge-to-edge mitral valve repair. Some reports revealed the impact of mean transmitral pressure gradient after procedure on long-term clinical outcomes. However, the association between prognosis and mitral valve orifice area (MVA) after the procedure has been poorly studied. This study aimed to investigate the association between postprocedural small MVA, derived from three-dimensional (3D) transesophageal echocardiography (TEE), and long-term clinical outcomes in 2 cohorts: the degenerative mitral regurgitation (MR) cohort and the functional MR cohort. This retrospective study assessed 279 consecutive patients with 3D TEE data during transcatheter edge-to-edge mitral valve repair between January 2010 and December 2016. Mitral valve orifice area after device implantation was measured by 3D planimetry. The patients with degenerative and functional MR were stratified separately into 2 groups according to postprocedural MVA: normal MVA (MVA > 1.5cm2) group and small MVA (MVA ≤ 1.5cm2) group. Of the 279 patients, 142 (51%) had degenerative MR and 137 (49%) had functional MR. The number of degenerative MR patients with small MVA was 38, whereas 42 patients were in the functional MR cohort. Patients with small MVA had higher rate of all-cause mortality in the degenerative MR group (log-rank test: P=.01) but not in the functional MR group (log-rank test: P=.52). In multivariate analysis small MVA was independently associated with all-cause mortality but not postprocedural transmitral pressure gradient. Neither small MVA nor transmitral pressure gradient was associated with all-cause mortality in patients with functional MR. Small MVA measured by 3D TEE after transcatheter mitral edge-to-edge repair was associated with poor prognosis in patients with degenerative MR.

Impact of post-percutaneous mitral balloon valvuloplasty mitral valve area indexed for the body size on long-term outcomes in rheumatic mitral stenosis: a 20-year retrospective analysis

Abstract Introduction Percutaneous mitral balloon valvuloplasty (PBMV) remains one of the standard treatments for symptomatic rheumatic mitral stenosis (MS)(1). The procedural success criteria are generally defined as a post-procedural mitral valve area (MVA) of more than 1.5 cm2 without significant mitral regurgitation or in-hospital complications(2, 3). However, the effect of body size on the post-procedural MVA is not well examined. Purpose This study intended to investigate the association between the different methods of indexing post-PBMV MVA for the body size parameters and event-free survival compared to the absolute MVA in rheumatic MS patients treated with PBMV. Methods We retrospectively enrolled clinically significant rheumatic MS patients (MVA ≤1.5 cm2) who underwent PBMV with Inoue balloon between June 2002 and February 2021. The patients who experienced in-hospital complications (stroke, emergency surgery, or death) were excluded. A final number of 584 out of 618 patients were included in the analysis. Post-procedural MVA was assessed using echocardiographic 2D planimetry or pressure half-time if planimetry was not available. Post-PBMV MVA was indexed by body surface area (BSA), body mass index (BMI), body weight or height. The median value of absolute MVA and indexed MVA was used to stratify patients into two groups. The primary outcome was the composite of death, repeat PBMV, and mitral valve surgery. We performed Cox regression analyses to assess the association between groups and outcomes. C-index was calculated to assess the discriminative ability of each index. Results The mean age was 41.5 (±11.9) years, and 490 patients (82.8%) were female. The prevalence of atrial fibrillation was 39.5%. The median Wilkin score was 8 (interquartile range of 7-9). The mean pre-procedural and post-procedural MVA was 0.92 (±0.24) and 1.57 (±0.28) cm2, respectively. The average pre-procedural and post-procedural mean pressure gradient was 13.1 (±6.3) and 5.7 (±3.0) mmHg, respectively. The prevalence of post-procedural MR in a moderately severe to a severe degree was 3.8%. Over a median follow-up of 3.9 years, 194 composite events occurred. Patients with post-procedural indexed MVA of any type greater than a median were not associated with a significantly lower risk of primary outcome compared to those with indexed MVA less than the median (Picture 1). Moreover, absolute MVA greater than a median (1.55 cm2) was independently associated with a lower risk of primary outcome after adjusting with age and gender (Hazard ratio [95% CI] = 0.658 [0.493-0.879], p = 0.005). The discriminative ability of the absolute MVA was highest than the indexed MVA (Picture 2). Conclusion Indexing post-procedural MVA did not provide additional benefit on long-term risk stratification after PBMV compared with the absolute MVA.

Abstract 16053: Mitral Valveception: The Promising Technique of Mitral Valve-in-Valve Replacement for Bioprosthetic Valve Dysfunction

Introduction: Degeneration of bioprosthetic mitral valves often presents as regurgitation or stenosis. The gold standard is surgical repair; however, many patients are considered too high risk for repair and therefore transcatheter mitral valve replacement (TMVR) can be considered in appropriately selected patients. We present a Mitral Valve in Valve (ViV) replacement as a rescue option for severe bioprosthetic mitral stenosis. Case: A 45-year-old male with a history of IV drug use, ischemic cardiomyopathy with placement of ICD and severe mitral regurgitation s/p bioprosthetic MVR (27mm Edwards) 7 years ago presented with dyspnea. He was found to have decompensated heart failure with evidence of cardiogenic shock. He required inotropes and admission to the Cardiac ICU. Echocardiogram demonstrated biventricular dysfunction with an EF of 15%, and a well-seated malfunctioning bioprosthetic valve with fixed posterior leaflets and severe degenerative stenosis (3D planimetry valve area 0.85cm2). His cardiogenic shock was felt to be in the setting of severe mitral stenosis on the background of underlying cardiomyopathy. He was deemed a poor surgical candidate by multidisciplinary team with an STS mortality and morbidity risk of 39% and 85%. He hence underwent a mitral ViV with successful placement of a 29mm Edwards SAPIEN 3 transcatheter valve with impella protection. Patient improved and was discharged off inotropes. Discussion: Surgical mitral valve replacement remains the standard of care currently for degenerated bioprosthetic mitral valves. Patients at heightened risk may require ViV procedure instead. In ViV, the ring of the bioprosthetic valve can serve as an anchoring point for the new valve. This avoids a major limitation with TMVR in the native mitral annulus. Severity of acute illness proved to be the determining factor heightening the need for ViV replacement as a rescue option in our patient. Conclusion: Management of failing surgical mitral bioprosthesis remains a challenge. ViV-TMVR is an evolving approach that can be used as an alternative in patients who are not surgical candidates. Low rates of periprocedural morbidity and mortality reported in literature strengthen the argument for TMVR, although more data is needed to guide management.

Which factors are associated with low flow in rheumatic mitral stenosis patients?

Stroke volume (SV) raised enthusiasm in the early investigations of rheumatic MS pathophysiology and was considered as a key component triggering dyspnea. Giving the discrepancies uncovered in later studies, its importance was later downgraded. The objective of this study was to assess correlations between LA reservoir function (LASr) and global left ventricular longitudinal strain (LVS) determined by 2D STE and stroke volume index (SVI). We performed TTE in a cohort of patients with rheumatic MS. Basic 2D and doppler parameters were recorded such as mean trans-mitral gradient (MTMG), mitral valve area (MVA) with 2D planimetry and PHT. Studied parameters represent mean of three consecutive cardiac cycles. LASr data was obtained on a dedicated 4C view with STE technique. LVS was generated based on the 3 basic apical views. Low-flow state was defined as a SVI ≤ 35 mL/m2. One hundred and ninety-five patients were included between February 2018 and October 2021. We divided our cohort into two groups: group I with SVI ≤ 35 mL/m2 and group II with SVI > 35 mL/m2. There was not a significant difference in terms of age (49.8 ± 12 vs. 51.6 ± 10 yrs, P = 0.3), sex (70.7 vs. 72.2% were female, P = 0.8) and history of atrial fibrillation (67.4 vs. 55.7%, P = 0.09). 2D MVA was significantly lower in group I (1.22 ± 0.4 vs. 1.43 ± 0.5 cm2, P = 0.003). Surprisingly, MVA determined with PHT did not significantly differ (1.43 ± 0.6 vs. 1.39 ± 0.4 cm2, P = 0.5). The incidence of severe dyspnea was (44.3 vs. 44.4%, P = 0.9). TRVmax levels (3.23 ± 0.6 vs. 3.07 ± 0.6 m/s, P = 0.14) were comparable. Group I had significantly higher MTMG (12.1 ± 7 vs. 9.8 ± 4 mmHg, P = 0.01). LVS and LVEF were significantly lower in low-flow patients: (−15 ± 4 vs. −18 ± 2%, P < 0.001) and (61.1 ± 8% vs. 64.2 ± 5%, P = 0.04) respectively. LASr was higher in normal flow patients but did not reach the statistical significance. (9.5 ± 7 vs. 11.5 ± 6%, P = 0.062). MVA, LVS and LVEF were significant associates of low-flow state in MS patients. LA reservoir function was not significantly correlated to SVI.

Assessment of left atrial reservoir function in rheumatic mitral stenosis with pulmonary hypertension

The pathophysiology triggering dyspnea in rheumatic MS patients remains not fully understood. Recently introduced echocardiographic techniques allowed the study of left atrial reservoir function (LASr) notably in patients with PH. The objective of this study was to assess the correlation between LASr determined by 2D STE derived from global LA strain and PH. We performed prospective 2D TTE in patients with rheumatic MS. 2D and doppler TTE parameters, including indexed LA volume, maximal trans tricuspid velocity (TRVmax), mean trans-mitral gradient (MTMG), valve area (MVA) using pressure half time (PHT), 2D and 3D planimetry and left ventricular index stroke volume, were recorded. Doppler parameters are determined as the mean of three measurements. Maximal TRVmax was used as an indicator of the degree of PH to ignore assumptions on the right atrial pressure. A TRVmax cut-off value ≥ 2.9 m/s was retained to determine an intermediate to high probability of PH. NYHA functional status was determined moments before performing the scan. We enrolled 195 patients with rheumatic MS, with a mean age of 50.55 ± 12.07 years (between February 2018 and October 2021). Patients were divided into two groups: group 1 had TRVmax ≥ 2.9 m/s and group 2 had TRVmax < 2.9 m/s. There was no difference in age (52 ± 12 vs. 49 ± 11, P = 0.16) and in sex (respectively 69.8% and 76.1% were female, P = 0.3). AF was comparable between the two groups (69.8 vs. 65.7%, P = 0.5). There was no difference in the incidence of severe dyspnea (48.8% vs. 43.1%, P = 0.5 had NYHA class III or I symptoms). Incidence of diabetes mellitus was significantly higher among patients with PH (24.4 vs. 10.6%, P = 0.02). Patients in the PH group had significantly higher MTMG (13 ± 6 vs. 8 ± 3 mmHg, P < 0.001) and significantly lower MVA (1.1 ± 0.5 vs. 1.5 ± 0.5 cm2, P < 0.001). LASr was significantly higher in patients without PH (11.1 ± 7 vs. 8.9 ± 5%, P = 0.05). LASr was associated with a lower incidence of pulmonary hypertension in patients with MS.

Photogrammetric state of degradation assessment of decorative claddings: the plasterwork of the Maidens' Courtyard (The Royal Alcazar of Seville)

Highlights: The photogrammetric survey demonstrates to be a potential tool in the preventive conservation of ancient plasterworks. The high-precision 3D model allows the study and quantification of alterations (e.g. fissures, deformations, and loss of mass or polychromies). The virtual model and the analysis performed with CloudCompare software provide fast, accurate and accessible results to experts in the field. Abstract: Previous studies and documentation about the state of conservation of architectural or decorative elements are crucial for heritage managers, technicians and researchers to succeed in the maintenance and preservation of the heritage. In this sense, hand tracings, digital drawings, or photographs have traditionally been the methods for alteration and sample mapping. In spite of their effectiveness, these methods have some disadvantages, such as the need for more precision in terms of location, dimensions, quantification and types of alterations. By contrast, high-resolution three-dimensional (3D) models allow us to analyse decorative ancient plasterworks with great precision, offering considerable advantages over traditional tools for heritage documentation. To facilitate stakeholders’ work and enhance the quality of data collected, this work proposes the use of photogrammetry as a tool for the documentation of polychromed ancient plasterworks, taking the upper frieze of the access door to the Charles V ceiling room in the Royal Alcazar of Seville as a case of study. Thus, the work methodology applied has shown several advantages over previous methods. On the one hand, it was possible to obtain a 2D planimetry from the 3D model; this is an essential step for those responsible for heritage, especially in reports prior to restoration interventions. On the other hand, the 3D model created enables present alterations identification, the location of fissures and cracks in their three dimensions (opening, length and depth), deformations measurement and control, the quantification of mass or polychrome loss, and the detached elements digital reconstruction. In this way, highprecision digital results are quickly obtained and accessible to all the experts involved in the heritage conservation and maintenance plan.

Early water management systems on the southern Transjordan plateau

The efficient management of water resources to supply the needs of societies in territories where water is a scarce and limited resource has been essential throughout time. The site of Sela on the southern Transjordan plateau is unique for understanding water management in this semi-arid area. The analysis of hydraulic installations has allowed us to characterise its hydro technology and spatial distribution in the settlement. To this end, the hydraulic facilities have been identified, documented, and analysed in detail through two archaeological surveys (2015 and 2016). Spatial analysis has been carried out by preparing extensive 2D planimetry and 3D reconstructions. The results obtained have made it possible to reconstruct the water supply system necessary for the subsistence of the societies that inhabited Sela over time. The system consists of canals, cisterns, and sedimentation basins for the collection, conduction, storage, and preservation of water, mainly from rain. Some of Sela's hydraulic structures may have originated in the Bronze Age (mid-late 2nd mill. BCE), but more secure dating is needed to substantiate this possibility.

843 QUANTIFICATION OF VENTRICULAR FUNCTIONAL MITRAL REGURGITATION USING THE VOLUMETRIC METHOD BY 3D-ECHOCARDIOGRAPHY

Abstract Background ventricular functional mitral regurgitation (v-FMR) is associated with an increased risk of mortality and hospitalization for heart failure. In this setting, the echocardiographic assessment of v-FMR severity using 2D proximal isovelocity surface area (PISA) yields several limitations, potentially leading to an underestimation of v-FMR severity. An alternative approach is to derive the regurgitant volume (RegVol) and the effective regurgitant orifice area (EROA) using the three-dimensional echocardiography (3DE) to estimate left ventricular volumes (volumetric method, VM). However, a direct comparison of these methods has never been tested. Accordingly, the aims of our study are: i; to compare both 2D PISA measurements of EROA and RegVol with those obtained by VM using 3DE, ii; to test their accuracy using the 3D planimetry of vena contracta area (3D-VCA) of MR jet, as reference. Methods we retrospectively analysed 82 (mean age 75±12, 48% men, 79% sinus rhythm, 85% with ischemic cardiomyopathy, 15% with dilated cardiomyopathy) consecutive patients with v-FMR and reduced left ventricular ejection fraction (LVEF &amp;lt;50%), acquired between July 2020 and October 2021. Exclusion criteria were: age &amp;lt; 18 years, primary MR, presence of intra-cardiac shunts, greater than mild aortic regurgitation, and inadequate acoustic window. PISA EROA was calculated using the formula: 6.28 r2×Va/Vp (where: r= PISA radius, Va= aliasing velocity, Vp= MR peak velocity). FMR regurgitant volume (RegVol) by PISA was calculated as EROA×VTIMR, where VTIMR represents the time–velocity integral of the CW Doppler MR jet tracing. FMR RegVol by 3DE volumetric method (VM) was calculated as: total LV stroke volume (LV SV) – forward LV SV (Ao SV). LV SV was obtained by subtracting the respective end-systolic (ESV) from the end-diastolic (EDV) volumes measured by 3DE. Ao SV was calculated by multiplying LV outflow area by LV outflow tract velocity time integral (VTI). EROA by VM was calculated as the MR RegVol divided by VTIMR. In a group of 10 patients, the quantification of 3D-VCA was performed by multiplanar reconstruction using a dedicated software package (EchoPAC 204 GE Vingmed, Horten, Norway). Results average LV end-diastolic and end-systolic volumes, total stroke volume, LVEF and global longitudinal strain were 211±25 mL, 134±17 mL, 73±9 mL, 36±8% and, 9.4±2.7% respectively. Median Ao SV was 50±12 mL. Left atrial volume and left atrial reservoir strain were respectively 99±19 mL and 10±16%. Both EROA and RegVol by VM were larger than EROA (0.17± 0.09 cm2 vs 0.11± 0.01 cm2; p&amp;lt;0.001) and RegVol (25.7±12.1 mL vs 17.2±9.9 mL; p&amp;lt;0.001) by PISA, respectively. Compared to 3D-VCA, EROA by VM resulted more accurate than EROA by PISA (bias= -0.15 cm2, LOA ±0.24 cm2 vs bias= -0.25 cm2, LOA ±0.29 cm2). Finally, VM EROA (r= 0.778) showed a better correlation than PISA EROA (r= 0.681) with the 3D-VCA (p&amp;lt;0.001). Conclusions in patients with v-FMR, the echocardiographic assessment of EROA and RegVol using the 3DE volumetric method showed larger values compared to the conventional PISA method, and a closer correlation with the 3D VCA. Accordingly, the 3DE VM could improve the accuracy of evaluation of v-FMR severity. Larger studies with longer clinical follow-up are needed to define if it translates into improved risk stratification and may address patients’ management.

Echocardiography in the Assessment of Valve Regurgitation- Incremental Role of Three Dimensional Echocardiography.

Echocardiography (Echo) has a primary role in the evaluation of cardiac valve regurgitation. Echo valve regurgitation assessment includes multiple qualitative and quantitative methods which require adequate image quality, comprehensive echocardiographic images and precise measurements to obtain accurate assessment. For patient management, it is also important to investigate the mechanism of valve regurgitation. Severity and mechanism of valve regurgitation determine whether continued medical follow up is optimal or surgical or percutaneous valve repair, or replacement option should be necessary. Transthoracic Echo (TTE) is the gold standard most commonly used for the assessment of valve leaflet anatomy, valve motion and regurgitation severity to determine primary versus secondary causes of valve regurgitation, however transesophageal echo (TEE) provides high resolution imaging of valve leaflets and supporting apparatus and oftentimes determines mechanism of valve regurgitation particularly for mitral and tricuspid valves when TTE is unable to determine the mechanism. By providing surgical type views in a moving heart under normal hemodynamic conditions, 3D TEE has greatly improved assessment of mechanism and etiology of valve regurgitation. Besides, TEE also allows quantitation of valve regurgitation severity by Doppler methods as well as direct 3D planimetry of valve area and regurgitant orifice area. Doppler methods are pre and afterload dependent whereas direct 3D planimetry allows assessment of location and severity of valve regurgitation irrespective of ventricular loading conditions. Pre or intraoperative 3D TEE assessment can provide valuable information for surgical planning of valve repair or replacement. This review discusses various valvular pathologies causing regurgitation and the role of TTE and TEE in improving this assessment as shown by several case examples.

IS 3D TRANSTHORACIC PLANIMETRY STILL SUPERIOR OVER 2D ECHO IN RHEUMATIC MITRAL STENOSIS WHEN BOTH AREA AND HEMODYNAMIC PARAMETERS OF SEVERITY ARE IN QUESTION?

Objectives: The objective of the study was to compare transthoracic 3D planimetry to 2D planimetry in calculating mitral valve area along with correlation of various echocardiographic parameters of severity of mitral stenosis among these modalities. Methodology: Patients with (RMS) were enrolled. Keeping 2D PHT as reference mitral valve area (MVA) was calculated and it was compared to the results derived by transthoracic 2D and 3D planimetry. Agreement between the 2D and 3D methods was assessed by measuring the intraclass correlation coefficient (ICC). Results: 51 patients were included. 36 (70.6%) were females; mean age was 33 ± 6 years. Mean gradient was 14.5 ± 3.9 mmhg while mean Pulmonary artery systolic pressure (PASP) was 31.6 ± 6 mmhg. MVA’s derived by PHT, 3D planimetry, and 2D were 1.04 ± 0.24, 1.07 ± 0.24, 1.21 ± 0.27 cm2 respectively. 3D obtained areas were significantly lower compared to 2D (p&lt; 0.001) and insignificantly greater from PHT (p = 0.18). 3D demonstrated best agreement with MVA PHT (95% limits of agreement: 0.67 to 0.92; ICC 0.84). MVA 3D planimetry and MVA 2D correlated well with PASP and mean pressure gradient but showed weak correlation with left atrium size. Conclusion: 3D planimetry derived mitral area compared to 2D echocardiography are more in line with PHT calculated area and correlates well to hemodynamic parameters of severity.

Orifice Areas of Balloon-Expandable Transcatheter Heart Valves: A Three-Dimensional Transesophageal Echocardiographic Study

Accurate expected effective orifice area (EOA) values for balloon-expandable (BE) transcatheter heart valves (THV) are crucial for preventing patient-prosthesis mismatch (PPM) and assessment of THV function. Currently published reference EOAs, however, are based on transthoracic echocardiography (TTE), which may be subject to left ventricular outflow tract diameter underestimation and/or suboptimal THV Doppler interrogation. The objective of this study was to establish reference EOA values for BE THVs on the basis of Doppler and three-dimensional (3D) transesophageal echocardiography (TEE). Two hundred twelve intraprocedural transesophageal echocardiographic examinations performed during BE THV implantation with optimal postimplantation Doppler and 3D imaging were retrospectively reviewed. Continuity equation-derived EOAs were compared with geometric orifice areas by 3D planimetry (GOA3D). Performance indices (i.e., EOA normalized to valve size) and PPM rates were determined. TTE-based EOAs obtained within 30days were also calculated in a subset of 170 patients. The average EOA for all BE THV valves (77% SAPIEN 3) was 2.3±0.5cm2, while the average EOA was 1.6±0.2cm2 for 20-mm, 2.0±0.2cm2, for 23-mm, 2.5±0.3cm2 for 26-mm, and 3.0±0.3cm2 for 29-mm THV size (P<.001). Bland-Altman analysis demonstrated very good agreement between EOA and GOA3D (bias -0.04±0.15cm2). There were strong correlations between annular area and TEE-based EOA (R=0.84) and GOA3D (R=0.87). The mean performance index was 47±5% and was similar for all THV sizes (P=.21). EOAs based on TTE were smaller compared with those based on TEE, while the correlation with annular area (R=0.67) and agreement with GOA3D (bias -0.26±0.43cm2) was not as strong. The overall PPM rate was 2% in the TEE cohort and 12% in the TTE cohort. EOAs for BE THVs based on intraprocedural Doppler and 3D TEE suggest that previously published TTE-based reference values for EOA are underestimated, while PPM rates may be overestimated. Our findings have important clinical implications for preimplantation decision-making and for the evaluation of THV hemodynamics and function during follow-up.

C96. The First Percutaneous Transvenous Mitral Commissurotomy guided by Three Dimensional Transesophageal Echocardiography in Haji Adam Malik General Hospital Medan

Abstract Background Percutaneous Transvenous Mitral Commissurotomy (PTMC) has become the treatment of choice for patients with mitral stenosis. PTMC guided by three-dimensional Transesophageal Echocardiography (3D-TEE) promise of greater safety and efficacy. Case Summary We report a 29-year-old woman who came to our outpatient clinic with shortness of breath as a chief complaint for the past three months. ECG depicted sinus rhythm. Transthoracic Echocardiography (TTE) and 3D-TEE showed severe mitral stenosis with MVA planimetry: 0.8 cm2, MV mean PG 12 mmHg, MV PHT 403 ms, Wilkins score was 4 and no thrombus was found. Therefore, we decided to do PTMC. We successfully done the antegrade transseptal puncture by fluoroscopy guided by two-dimensional (2D) TEE . Then, we used Inoue-balloon catheter No. 24 to dilate the mitral valve. Afterthat, we did 3D-TEE evaluation of the mitral valve area and it showed a significant improvement, with MVA 3D planimetry: 2.0 cm2 and MV mean PG: 4 mmHg and we found moderate mitral regurgitation (MR VC 0.4 cm, MR PISA: 0.3 cm), so we decided to end the procedure. Discussion In this case, the PTMC procedure was carried with 2D and 3D-TEE guiding, where process run more easily because interventionist can ensure the targeted site during transeptal puncture, navigation to the mitral valve and post inflation inspection. 3D-TEE guiding can also directly ensure the success of PTMC in real time by evaluating the MVA planimetry (pre and post PTMC) and the mitral regurgitation.

C96. The First Percutaneous Transvenous Mitral Commissurotomy guided by Three Dimensional Transesophageal Echocardiography in Haji Adam Malik General Hospital Medan

Abstract Background Percutaneous Transvenous Mitral Commissurotomy (PTMC) has become the treatment of choice for patients with mitral stenosis. PTMC guided by three-dimensional Transesophageal Echocardiography (3D-TEE) promise of greater safety and efficacy. Case Summary We report a 29-year-old woman who came to our outpatient clinic with shortness of breath as a chief complaint for the past three months. ECG depicted sinus rhythm. Transthoracic Echocardiography (TTE) and 3D-TEE showed severe mitral stenosis with MVA planimetry: 0.8 cm2, MV mean PG 12 mmHg, MV PHT 403 ms, Wilkins score was 4 and no thrombus was found. Therefore, we decided to do PTMC. We successfully done the antegrade transseptal puncture by fluoroscopy guided by two-dimensional (2D) TEE . Then, we used Inoue-balloon catheter No. 24 to dilate the mitral valve. Afterthat, we did 3D-TEE evaluation of the mitral valve area and it showed a significant improvement, with MVA 3D planimetry: 2.0 cm2 and MV mean PG: 4 mmHg and we found moderate mitral regurgitation (MR VC 0.4 cm, MR PISA: 0.3 cm), so we decided to end the procedure. Discussion In this case, the PTMC procedure was carried with 2D and 3D-TEE guiding, where process run more easily because interventionist can ensure the targeted site during transeptal puncture, navigation to the mitral valve and post inflation inspection. 3D-TEE guiding can also directly ensure the success of PTMC in real time by evaluating the MVA planimetry (pre and post PTMC) and the mitral regurgitation.

Assessment of mitral valve area by 3D planimetry after percutaneous mitral valve repair

Abstract Background Percutaneous mitral valve (MV) repair has become an effective therapeutic alternative to MV surgery in high-risk surgical patients with severe MR. Persistent pulmonary hypertension after mitral valve replacement has shown an increased risk of morbidity and mortality. Improvement of pulmonary systolic arterial pressure (PSAP) post-MitraClip has been reported, however relative mitral stenosis may hamper this benefit. Few data is available regarding the best echocardiographic parameter to determine mitral stenosis after the procedure. Purpose To evaluate the correlation between the residual mitral valve area (MVA) by 3D planimetry, the pressure half time (PHT) and the transmitral gradient after percutaneous edge-to-edge mitral repair. Methods This is a single-center, retrospective study. We enrolled 88 consecutive patients who underwent a percutaneous MV repair with the MitraClip system between 2010 and 2020 at our tertiary university hospital, with eligibility evaluation by transesophageal echocardiogram (TEE). All patients had moderate to severe (3+) or severe (4+) primary or secondary MR. Results The mean age was 76.2±10.4 years and 64.8% of the patients were male. Above 88% of patients were in New York Heart Association class III/IV. Baseline 3D planimetry MVA was 5.3±1.4cm2 and mean gradient pre-implantation was 1.8±0.8mmHg. After the procedure, MVA reduced to 2.9±0.8cm2 and mean gradient was 2.8±1.4mmHg. Both 3D planimetry and mean gradient were very significantly correlated (r −0.5; p&amp;lt;0.001) (Figure 1), whereas no correlation was note between mean gradient and PHT (r 0.17; p=0.117) Conclusion After MitraClip implantation, the assessment of mitral valve area by 3D planimetry is significantly correlated with the transmitral mean gradient, unlike PHT. Funding Acknowledgement Type of funding sources: None. Figure 1. Correlation of post-procedural 3D MVA and transmitral mean gradient

PD05-03 ANDROGEN DEPRIVATION THERAPY (ADT) FOR PROSTATE CANCER AND ITS EFFECTS ON BRAIN VOLUME 3D PLANIMETRY

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) I (PD05)1 Sep 2021PD05-03 ANDROGEN DEPRIVATION THERAPY (ADT) FOR PROSTATE CANCER AND ITS EFFECTS ON BRAIN VOLUME 3D PLANIMETRY Ruel Neupane, Megan Prunty, Danly Omil-Lima, Amr Mahran, Kirtishri Mishra, Lee Ponsky, Carvell Nguyen, Christopher Kondray, Adam Calaway, and Laura Bukavina Ruel NeupaneRuel Neupane More articles by this author , Megan PruntyMegan Prunty More articles by this author , Danly Omil-LimaDanly Omil-Lima More articles by this author , Amr MahranAmr Mahran More articles by this author , Kirtishri MishraKirtishri Mishra More articles by this author , Lee PonskyLee Ponsky More articles by this author , Carvell NguyenCarvell Nguyen More articles by this author , Christopher KondrayChristopher Kondray More articles by this author , Adam CalawayAdam Calaway More articles by this author , and Laura BukavinaLaura Bukavina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001969.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Approximately 1 in 9 American men will be diagnosed with prostate cancer. Androgen Deprivation Therapy (ADT) is commonly given for advanced local and metastatic prostate cancer with evidence of prolonged survival. However, there is increasing concern for the negative side effects including cognitive decline in ADT users. Our study seeks to quantify radiographic changes on brain parenchyma following ADT. METHODS: A retrospective multi-institutional study was performed on baseline and follow-up computerized tomography (CT) head scans of 59 men prior to and after initiation of ADT. All CT imaging were reviewed using 3D planimetry software (3D Splicer, Version 4.10.2). Brain and ventricular volumes were assessed via segmentation protocol. Multivariate logistic regression (MVR) adjusting for socio-demographic variables and comorbidities were used to assess risk factors for cortical loss. Paired Wilcoxon test was utilized to assess change in brain volume prior to and after initiation of ADT. RESULTS: A total of 59 patients were analyzed. An average decline in cortical volume of 86.2 cm3 [pre-ADT 1156.0 cm3 (1035.0, 1231.5) and post-ADT 1073.0cm3 (930.5, 1136.5), p>0.001] was seen in our cohort. As expected, sequential increase of 30% in ventricular volume from baseline (66 cm3) to post-ADT (84 cm3) was also noted. On MVR, lower BMI (OR 1.13, 95%CI 1,01-1.27, p=0.042), history of dementia (OR 3.47, 95% CI 1.05-12.66, p=0.042) and alcohol abuse (OR 4.7, 95%, CI 1.1-21.01, p=0.037) were all significantly associated with increased the risk of cortical loss. History of metastatic prostate cancer was not associated with risk of cortical loss (Figure 1C). CONCLUSIONS: Androgen deprivation therapy is commonly used for the management of localized and metastatic prostate cancer. There is mounting evidence that ADT may be correlated with loss of brain volume and cognitive decline. In this study we quantify the loss of cortical brain volume and ventricular expansion in patients on ADT. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e56-e56 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruel Neupane More articles by this author Megan Prunty More articles by this author Danly Omil-Lima More articles by this author Amr Mahran More articles by this author Kirtishri Mishra More articles by this author Lee Ponsky More articles by this author Carvell Nguyen More articles by this author Christopher Kondray More articles by this author Adam Calaway More articles by this author Laura Bukavina More articles by this author Expand All Advertisement Loading ...