Valve Area In Patients Research Articles

Mitral Annulus Calcium Score in Patients With Calcific Mitral Stenosis Undergoing Invasive Hemodynamic Assessment.

Aortic valve calcium score is associated with hemodynamic severity of aortic stenosis. Whether this association is present in calcific mitral stenosis remains unknown. This study was a retrospective analysis of consecutive patients with mitral stenosis secondary to mitral annular calcification (MAC) undergoing transseptal catheterization. All patients underwent invasive mitral valve assessment via direct left atrial and left ventricular pressure measurement. Computed tomography within 1 year of cardiac catheterization and with adequate visualization of the mitral annulus was included. MAC calcium score quantification by Agatston method was obtained offline using dedicated software (Aquarius, TeraRecon, V.4). Median patient age was 66.9±11.2 years, 47% of patients were women, 50% had coronary artery disease, 40% had atrial fibrillation, 47% had prior cardiac surgery, and 33% had prior chest radiation. Median diastolic mitral valve gradient was 9.4±3.4 mm Hg on echocardiography and 8.5±4 mm Hg invasively. Invasive median mitral valve area using the Gorlin formula was 1.87±0.9 cm2. Median MAC calcium score for the cohort was 7280±7937 Hounsfield units. MAC calcium score correlated with the presence of atrial fibrillation (P=0.02) but was not associated with other comorbidities. There was no correlation between MAC calcium score and mitral valve area (r=0.07; P=0.6) or mitral valve gradient (r=-0.03; P=0.8). MAC calcium score did not correlate with invasively measured mitral valve gradient and mitral valve area in patients with MAC-related mitral stenosis, suggesting that calcium score should not be used as a surrogate for invasive hemodynamic parameters.

Relationship between echocardiographic parameters and ALBI score in patients with rheumatic mitral stenosis.

An increase in the volume and pressure of the heart chambers has been shown to increase liver stiffness. The Albumin-Bilirubin (ALBI) score is useful and easy-to-use for objectively assessing liver function. There is no information in the literature regarding changes in ALBI scores in patients with rheumatic mitral stenosis (MS). The aim of our study was to investigate changes in ALBI score and its clinical impact in patients with MS.Of the 247 patients analyzed, 54 were excluded from the study. The remaining 193 patients with MS were divided into two groups: Group I (64 patients with mitral valve area > 1.5 cm2 and mean transmitral gradient < 10 mmHg) and Group II (129 patients with mitral valve area ≤ 1.5 cm2 and mean transmitral gradient ≥ 10 mmHg). The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI= (log10 bilirubin [µmol/L] × 0.66) + (albumin [g/L] × - 0.085).A significant correlation was found between the ALBI score and mitral valve area in patients with MS (r = - 0.479, p < 0.001*) (Table4; Fig.3A). An ALBI score greater than - 2.61 was associated with severe MS (mitral valve area < 1.5 cm2), with a sensitivity of 72% and a specificity of 69% (Area under the ROC curve = 0.726; p < 0.001; 95% CI 0.650-0.802) (Fig.4A). A significant correlation was found between the ALBI score and mean transmitral gradient in patients with MS (r = 0.476; p < 0.001*) (Table4; Fig.3B). An ALBI score greater than - 2.57 was associated with severe MS (mean transmitral gradient < 10 mmHg), with a sensitivity of 65% and a specificity of 67% (Area under the ROC curve = 0.684; p < 0.001; 95% CI 0.608-0.759) (Fig.4B). In multivariate linear regression analysis, mitral valve area and mean transmitral gradient were significantly associated with increased ALBI scores (p < 0.05).Mitral valve area, mean transmitral gradient, and NT-proBNP levels were significantly associated with the ALBI score. The ALBI score could provide an information about the severity of MS. The ALBI score is a simple, evidence-based, objective, and discriminatory method for assessing liver function in patients with MS.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Authors and their respective affiliations are correctly identified.

Reproducibility of transthoracic 3D echocardiography in the assessment of mitral valve area in patients with rheumatic mitral stenosis: real time versus ECG-gated 3D echocardiography.

To assess reproducibility of Real time 3D echocardiography (RT3D) and ECG-gated 3D echocardiography (EG3D) when measuring the mitral valve area (MVA) in rheumatic mitral stenosis (MS). MVA was assessed by three operators in 68 MS patients using RT3D and EG3D. Reproducibility of each technique was determined by calculating the standard error of measurements (SEM). SEM was similar between RT3D and EG3D. MVA variability was of 0.4cm² or 30% of any RT3D or EG3D measured MVA. The minimal change in MVA above which two measurements should be considered to differ significantly for the same operator was of 0.4cm² for RT3D and 0.5cm² for EG3D. For two different operators making successive measurements, the minimum significant change was of 0.5cm² for RT3D and 0.6cm² for EG3D. The minimum significant difference when switching from RT3D to EG3D or vice versa is of 0.6cm². Low temporal resolution of 6Hz has the least variability when using RT3D (0.19cm² vs. 0.26cm², p = 0.009) but significantly underestimated MVA (1.3 ± 0.4cm² vs. 1.4 ± 0.4cm², p < 10- 3) when compared to EG3D. MVA variability was significantly higher in mild MS when compared to severe MS whether it is RT3D (0.23cm² vs. 0.18cm², p = 0.02) or EG3D (0.27cm² vs. 0.16cm², p < 0.001). RT3D and EG3D are equally reproducible in the assessment of MVA in patients with MS. Further measurements standardization is required to have a clinically acceptable estimations of the true 3D MVA and minimal detectable differences.

Multiperspective Three-Dimensional Transthoracic Echocardiographic Assessment of Mitral Valve Area in Patients With Rheumatic Mitral Stenosis

Rheumatic mitral stenosis (MS) remains common in low- and middle-income countries with significant morbidity and mortality.1,2 Echocardiographic planimetry of the mitral valve (MV) area (MVA) correlates with anatomic MVA of explanted valves better than MVA estimated by other methods.3 Three-dimensional (3D) echocardiography provides better alignment of the imaging plane at the mitral leaflet tips, yielding a more accurate planimetric measurement of the MVA.4

Abstract 11582: Prognostic Implications of Anatomical Aortic Valve Area in Patients with Bicuspid Aortic Stenosis by Three-Dimensional Transesophageal Echocardiography

Background: Three-dimensional (3D) transesophageal echocardiography (TEE) provides high-resolution images of aortic valve area (AVA) in patients with bicuspid aortic stenosis (AS). However, the correlation with pressure gradient compared with conventional echocardiographic indices and prognostic implications of 3D TEE derived valve area (AVA 3DTEE ) has not been evaluated. Therefore, we assessed the disease severity and the prognostic value of AVA 3DTEE in patients with bicuspid AS. Methods: We retrospectively analyzed 105 patients with at least mild bicuspid AS (peak aortic velocity &gt;2.5m/sec) and LVEF ≥50% (mean transaortic pressure gradient 46±17 mm Hg) underwent transthoracic echocardiography, two-dimensional (2D) and 3D TEE between 2012 and 2019. AVA was measured using (i) the continuity equation (CE) obtained with transthoracic echocardiography, (ii) planimetric 2D TEE, and (iii) volumetric 3D TEE. Cardiac events were defined as surgical or transcatheter aortic valve replacement and/or aortic replacement, heart failure admission, or cardiac death. Results: AVA 3DTEE was larger than AVA CE (mean difference 0.21±0.03, P &lt;0.001), and smaller than AVA 2DTEE (mean difference 0.11±0.02, P &lt;0.001). AVA 3DTEE had an excellent correlation with mean transaortic pressure gradient (r=0.91, P &lt;0.001), whereas AVA 2DTEE and AVA CE showed lower correlations (r=0.81 and r=0.59, both P &lt;0.001). AVA 3DTEE significantly reduced the proportion of inconsistent AS grading, compared with AVA CE (6% versus 17%, P &lt;0.001). During a follow-up period (median, 853 days; range 513 to 1287 days), 101 surgical or transcatheter aortic valve replacement and/or aortic replacement, 6 heart failure admission, or 1 cardiac death occurred. AVA 3DTEE ≤1cm 2 was an independent predictor of cardiac events (adjusted hazard ratio (HR) 2.40, (1.41 to 4.09), P =0.001) and AVA 3DTEE of 1 cm 2 was the optimal cutoff value for predicting cardiovascular events with sensitivity of 71% and specificity of 100%. Conclusions: AVA measured by 3D TEE has a good correlation with mean transaortic pressure gradient and improved the hitherto inconsistent AS grading. AVA 3DTEE ≤1cm 2 is an important predictor for cardiac events of patients with bicuspid AS.

Elements of Immunoglobulin E Network Associate with Aortic valve Area in Patients with Acquired Aortic Stenosis.

Allergic mechanisms are likely involved in atherosclerosis and its clinical presentations, such as coronary artery disease (CAD). It has been previously reported that CAD severity associates with serum levels of immunoglobulin E (IgE), the molecule that, along with its high-affinity receptor (FcԑRI), plays a central role in allergic reactions. Considering multiple pathophysiological similarities between atherosclerosis and acquired aortic (valve) stenosis (AS), we speculated that allergic pathways could also contribute to the AS mechanisms and grading. To validate this hypothesis, we first checked whether total serum IgE levels associate with echocardiographic markers of AS severity. Having found a positive correlation between serum IgE and aortic valve area (AVA), we further speculated that also total IgE-determining genetic polymorphisms in FCER1A, a locus encoding an allergen-biding FcԑRI subunit, are related to acquired AS severity. Indeed, the major allele of rs2251746 polymorphism, known to associate with higher IgE levels, turned out to correlate with larger AVA, a marker of less severe AS. Our findings surprisingly suggest a protective role of IgE pathways against AS progression. IgE-mediated protective mechanisms in AS require further investigations.

Estimation of Stroke Volume and Aortic Valve Area in Patients with Aortic Stenosis: A Comparison of Echocardiography versus Cardiovascular Magnetic Resonance

In aortic stenosis, accurate measurement of left ventricular stroke volume (SV) is essential for the calculation of aortic valve area (AVA) and the assessment of flow status. Current American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines suggest that measurements of left ventricular outflow tract diameter (LVOTd) at different levels (at the annulus vs 5 or 10mm below) yield similar measures of SV and AVA. The aim of this study was to assess the effect of the location of LVOTd measurement on the accuracy of SV and AVA measured on transthoracic echocardiography (TTE) compared with cardiovascular magnetic resonance (CMR). One hundred six patients with aortic stenosis underwent both TTE and CMR. SV was estimated on TTE using the continuity equation with LVOTd measurements at four locations: at the annulus and 2, 5, and 10mm below annulus. SV was also determined on CMR using phase contrast acquired in the aorta (SVCMR-PC), and a hybrid AVACMR-PC was calculated by dividing SVCMR-PC by the transthoracic echocardiographic Doppler aortic velocity-time integral. Comparison between methods was made using Bland-Altman analysis. Compared with the referent method of phase-contrast CMR for the estimation of SVCMR-PC and AVACMR-PC (SVCMR-PC 83±16mL, AVACMR-PC 1.27±0.35cm2), the best agreement was obtained by measuring LVOTd at the annulus or 2mm below (P= NS), whereas measuring 5 and 10mm below the annulus resulted in significant underestimation of SV and AVA by up to 15.9±17.3mL and 0.24±0.28cm2, respectively (P<.01 for all). Accuracy for classification of low flow was best at the annulus (86%) and 2mm below (82%), whereas measuring 5 and 10mm below the annulus significantly underperformed (69% and 61%, respectively, P<.001). Measuring LVOTd at the annulus or very close to it provides the most accurate measures of SV and AVA, whereas measuring LVOTd 5 or 10mm below significantly underestimates these parameters and leads to significant overestimation of the severity of aortic stenosis and prevalence of low-flow status.

A Pilot Study Comparing Aortic Valve Area Estimates Derived from Fick Cardiac Output with Estimates Based on Cheetah-NICOM Cardiac Output

Cardiac output during cardiac catheterization is often estimated using the modified Fick method (COFick). In this proof-of-concept, prospective non-randomized study carried out in a single academic healthcare centre, we examined whether replacing COFick in the Gorlin formula with Cheetah-NICOM monitor cardiac output (COCheetah) could produce an accurate and precise estimate of aortic valve area in patients with severe aortic stenosis. In twenty-six subjects, COFick and COCheetah were obtained concurrently. A spot and 3-minute running average of COCheetah was used. Bland and Altman analysis was used to derive bias, 95% limits of agreement (LOA) and confidence intervals (CI). The mean difference (bias) between AVACheetah (average) and AVAFick was 0.11 cm2 and the 95% LOA were ±0.42 cm2. The 95% CI of the bias was 0.02–0.2 cm2. The bias and 95% LOA of AVACheetah (spot value) were 0.14 ± 0.42cm2, with a 95% CI of 0.06–0.23 cm2. No proportional bias was present. AVACheetah thus appears to be a reasonably accurate measure of AVA in patients with severe aortic stenosis compared to AVAFick measured using a modified Fick CO. However, the limits of agreement were not narrow enough to consider AVACheetah and AVAFick interchangeable.

Factors responsible for left atrial clot formation in patients with mitral stenosis and normal sinus rhythm

Background: The objective of the study was to investigate the factors responsible for left atrial (LA) clot formation in patients with mitral valve stenosis in normal sinus rhythm.Methods: 79 patients (43 males and 36 females) were included in the study. 9 patients with mitral stenosis in normal sinus rhythm had LA clot or LA smoke in echocardiography included in Group A and rest of 70 patients in Group B. LA size, gradient across mitral valve and mitral valve surface area was studied and compared in patients with or without LA clot/smoke.Results: Mean LA size was 4.8 (±0.5) and 4.6 (±0.7) in group A and B respectively with (p=0.304) and mean valve gradient was 11.6 (±2.8) and 10.6 (±3.5) in group A and B respectively with (p=0.507), the difference was not significant in both. Mean mitral valve area was 1.01 (±0.3) and 1.12 (±0.5) in group A and B (p=0.36), the difference was not significant.Conclusions: Study concluded that there was no significant difference in LA size, valve gradient and mitral valve area in patients with or without LA clot having mitral valve stenosis in normal sinus rhythm. Patients with LA clot warrant measures to prevent thromboembolic episodes.

P6054Calcium score of the mitral valve assessed by CT angiography correlates with the severity of mitral regurgitation and mitral valve area in patients with severe aortic stenosis

P6054Calcium score of the mitral valve assessed by CT angiography correlates with the severity of mitral regurgitation and mitral valve area in patients with severe aortic stenosis

AORTIC VALVE AREA/PEAK VELOCITY DISCORDANCES IN BICUSPID AORTIC VALVES

Recent data suggest significant discrepancies in the grade of aortic stenosis based on peak velocity versus valve area in patients with bicuspid aortic valve (BAV) (Figure, top). We investigated the incidence of such discordances in a large cohort. Echocardiograms in 243 adults with BAV were

Echocardiographic 3D-guided 2D planimetry in quantifying left-sided valvular heart disease.

Echocardiographic 3D-guided 2D planimetry can improve the accuracy of valvular disease assessment. Acquisition of 3D pyramidal dataset allows subsequent multiplanar reconstruction with accurate orthogonal plane alignment to obtain the correct borders of an anatomic orifice or flow area. Studies examining the 3D-guided 2D planimetry approach in left-sided valvular heart disease were identified and reviewed. The strongest evidence exists for estimating mitral valve area in patients with rheumatic mitral valve stenosis and vena contracta area in patients with mitral regurgitation (both primary and secondary). 3D-guided approach showed excellent feasibility and reproducibility in most studies, as well as time efficiency and good correlation with reference and comparator methods. Therefore, 3D-guided 2D planimetry can be used as an important clinical tool in quantifying left-sided valvular heart disease, especially mitral valve disorders.

A novel method to measure mitral valve area in patients with rheumatic mitral stenosis using three-dimensional transesophageal echocardiography: Feasibility and validation.

Neither two- nor three-dimensional (3D) planimetry of the mitral valve (MV) orifice takes the mitral commissures into account. Thus, if the commissures are not completely fused, the MV orifice will not be planar, and MV area (MVA) will be underestimated. The study aimed to validate a novel method for measurement of the MVA using a software that traces the MV orifice including the commissures. The study included 30 patients undergoing percutaneous balloon mitral valvuloplasty for severe rheumatic mitral stenosis. All performed 3D transesophageal echocardiography (TEE) immediately before the procedure. MVA was measured using the mitral valve navigation (MVN) software of the Philips Q-Lab 10.2 in a diastolic frame with maximum diastolic opening of the MV. Regular 3D planimetry of the MV orifice was also performed. Before balloon dilation, the MVA was calculated invasively using the Gorlin's formula. No significant difference was detected between MVN-derived MVA and Gorlin-derived MVA (0.98cm2 vs. 1.0cm2 , P=.33). A statistically significant difference was detected between Planimetry-derived MVA and Gorlin-derived MVA (0.8cm2 vs. 1.0cm2 , P<.001). There were significant linear correlations between MVN-derived MVA and Gorlin-derived MVA (r=.84, P<.001). Using Bland-Altman analysis, Gorlin-derived MVA showed better and relatively narrower limits of agreement with MVN-derived MVA than planimetry-derived MVA. Measurement of the MVA using the MVN method is feasible and is more correlated to the invasively measured MVA than the 3D planimetry method. This is the most accurate method of measuring the MVA that takes MV commissures into account.

Clinical standard for valve area after common atrioventricular valve plasty for a single ventricle.

To determine a clinical standard for post-repair common atrioventricular valve orifice area based on mid- to long-term valve function in patients with a functional single ventricle. The medical records of 19 single-ventricle patients who underwent common atrioventricular valve plasty from July 1988 to January 2013 were retrospectively reviewed. Bivalvation valvuloplasty was performed in 7 patients with relatively hypoplastic leaflets. The relationship between the orifice area of the repaired common atrioventricular valve measured intraoperatively and valve function and ventricular volume in the early postoperative period (median, 9.5 months) and at mid- to long-term follow-up (median, 4 years) were analysed. Post-repair valve area was significantly positively correlated with valve regurgitation severity in the early postoperative period (P = 0.001, r = 0.69) and at mid- to long-term follow-up (P = 0.02, r = 0.57). Patients who did not undergo bivalvation had favourable valve function at mid- to long-term follow-up and in the early postoperative period when the post-repair valve area was 96-136% of the normal mitral valve area. Bivalvation patients had significantly more valve regurgitation in the early postoperative period than patients without bivalvation, despite equivalent repaired valve area (P = 0.02). The post-repair orifice area of the common atrioventricular valve is significantly related to postoperative valve function. The clinical standard of post-repair valve orifice area might be 96-136% of the normal mitral valve area in patients undergoing repair without bivalvation. Patients undergoing bivalvation require greater reduction to obtain favourable mid- to long-term valve function.

Assessment of mitral valve area in patients with mitral stenosis with 3-dimensional proximal isovelocity surface area

Objective To determine the most suitable Nyquist velocity for applying the threedimensional proximal isovelocity surface area (PISA) (3d-PISA) to calculate mitral valve area (MVA) in patients with mitral stenosis (MS).Methods 20 patients with MS were studied by single-beat three-dimensional color Doppler echocardiography.The MVA was measured by the methods of planimetry (MVApl),two-dimensional PISA (MVA2d-PISA) and 3d-PISA (MVA3d-PISA).MVApl was used as reference methods.At the Nyquist velocities of 32,26 and 19 cm/s,the differences between MVA2d-PISA,MVA3d-PISA and MVApl were analyzed,and then the correlation between MVA2d-PISA,MVA3d-PISA and MVApl were analyzed respectively.Results The 3d-PISA method provided the most accurate estimation of MVA at the Nyquist velocity of 19 cm/s when compared with planimetry.MVA3d-PISA was more accurate than MVA2d-PISA.The acceptable correlations were observed between MVA3d-PISA,MVA2d-PISA and MVApl respectively (r =0.98,r =0.89).Conclusions The 3d-PISA method provided the most accurate estimation of MVA at the Nyquist velocity of 19 cm/s,which provided a new method to calculate mitral valve area with mitral stenosis. Key words: Echocardiography; Mitral valve stenosis; Three-dimensional proximal isovelocity surface area; Nyquist velocity

Endothelial microparticles increase in mitral valve disease and impair mitral valve endothelial function

Mitral valve endothelial cells are important for maintaining lifelong mitral valve integrity and function. Plasma endothelial microparticles (EMPs) increased in various pathological conditions related to activation of endothelial cells. However, whether EMPs will increase in mitral valve disease and their relationship remains unclear. Here, 81 patients with mitral valve disease and 45 healthy subjects were analyzed for the generation of EMPs by flow cytometry. Human mitral valve endothelial cells (HMVECs) were treated with EMPs. The phosphorylation of Akt and endothelial nitric oxide synthase (eNOS), the association of eNOS and heat shock protein 90 (HSP90), and the generation of nitric oxide (NO) and superoxide anion (O(2)(∙-)) were measured. EMPs were increased significantly in patients with mitral valve disease compared with those in healthy subjects. EMPs were negatively correlated with mitral valve area in patients with isolated mitral stenosis. EMPs were significantly higher in the group with severe mitral regurgitation than those in the group with mild and moderate mitral regurgitation. Furthermore, EMPs were decreased dramatically in both Akt and eNOS phosphorylation and the association of HSP90 with eNOS in HMVECs. EMPs decreased NO production but increased O(2)(∙-) generation in HMVECs. Our data demonstrated that EMPs were significantly increased in patients with mitral valve disease. The increase of EMPs can in turn impair HMVEC function by inhibiting the Akt/eNOS-HSP90 signaling pathway. These findings suggest that EMPs may be a therapeutic target for mitral valve disease.

Simplifying proximal isovelocity surface area as an assessment method of mitral valve area in patients with rheumatic mitral stenosis by fixing aliasing velocity and mitral valve angle

We aimed to test the ability of a simple equation using proximal isovelocity surface area method (PISA), created by fixing the angle to 100° and the aliasing velocity to 33cm/s, to calculate mitral valve area (MVA) and assess severity in patients with rheumatic mitral stenosis (MS). Methods and resultsIn a series of 51 consecutive patients with rheumatic MS, MVA was assessed by four methods, conventional PISA equation (PISAconventional), simple PISA equation (PISAsimple), pressure half time (PHT), and planimetry (PLN) which was taken as the reference method. All methods correlated significantly with PLN with the highest correlation found in case of PISAconventional and PISAsimple (r=0.97, 0.96, p<0.001), while the correlation in case PHT was relatively weaker (r=0.69, p<0.001). Bland–Altman analysis revealed that the level of agreement with PLN was better in case of both PISA methods than PHT and, moreover, were close to each other. The number of cases that showed agreement of severity grade with planinetry was better in case of PISAconventional (42 cases) and PISAsimple (44 cases) than that in case of PHT (34 cases, p=0.037). Finally, the measure of agreement with Cohen’s Kappa test was better in case of PISAconventional and PISAsimple than that in case of PHT. ConclusionProvided that aliasing velocity is fixed at 33cm/s, PISA can effectively predict mitral valve area and severity of MS by a simple equation, with the advantage of easy and accurate calculation over other methods.

Comparison of Left Ventricular Outflow Geometry and Aortic Valve Area in Patients With Aortic Stenosis by 2-Dimensional Versus 3-Dimensional Echocardiography

The present study sought to elucidate the geometry of the left ventricular outflow tract (LVOT) in patients with aortic stenosis and its effect on the accuracy of the continuity equation-based aortic valve area (AVA) estimation. Real-time 3-dimensional transesophageal echocardiography (RT3D-TEE) provides high-resolution images of LVOT in patients with aortic stenosis. Thus, AVA is derived reliably with the continuity equation. Forty patients with aortic stenosis who underwent 2-dimensional transthoracic echocardiography (2D-TTE), 2-dimensional transesophageal echocardiography (2D-TEE), and RT3D-TEE were studied. In 2D-TTE and 2D-TEE, the LVOT areas were calculated as π × (LVOT dimension/2)(2). In RT3D-TEE, the LVOT areas and ellipticity ([diameter of the anteroposterior axis]/[diameter of the medial-lateral axis]) were evaluated by planimetry. The AVA is then determined using planimetry and the continuity equation method. LVOT shape was found to be elliptical (ellipticity of 0.80 ± 0.08). Accordingly, the LVOT areas measured by 2D-TTE (median 3.7 cm(2), interquartile range 3.1 to 4.1) and 2D-TEE (median 3.7 cm(2), interquartile range 3.1 to 4.0) were smaller than those by 3D-TEE (median 4.6 cm(2), interquartile range 3.9 to 5.3; p <0.05 vs both 2D-TTE and 2D-TEE). RT3D-TEE yielded a larger continuity equation-based AVA (median 1.0 cm(2), interquartile range 0.79 to 1.3, p <0.05 vs both 2D-TTE and 2D-TEE) than 2D-TTE (median 0.77 cm(2), interquartile range 0.64 to 0.94) and 2D-TEE (median 0.76 cm(2), interquartile range 0.62 to 0.95). Additionally, the continuity equation-based AVA by RT3D-TEE was consistent with the planimetry method. In conclusion, RT3D-TEE might allow more accurate evaluation of the elliptical LVOT geometry and continuity equation-based AVA in patients with aortic stenosis than 2D-TTE and 2D-TEE.

Real-time 3D transoesophageal measurement of the mitral valve area in patients with mitral stenosis

Planimetry measured by two-dimensional transthoracic echocardiography (TTE, MVA2D) is the reference method for the evaluation of the severity of mitral stenosis (MS) but requires experienced operators and good echocardiographic windows. Real-time three-dimensional transoesophageal echocardiography (3D-TEE, MVA3D) may overcome these limitations but its accuracy has never been evaluated. We prospectively enrolled 80 patients (58±15 years, 86% female) referred for MS evaluation who underwent, within 1 week, a clinically indicated TTE and TEE. MVA2D was measured by experienced operators (Level III), MVA3D by one experienced and one non-experienced (Level I) operators blinded of any clinical or TTE information. MVA3D measured by the experienced operator [1.11±0.32 cm2; median, 1.1 cm2; range (0.45-2.20)] did not differ from and correlated well with MVA2D [1.10±0.34 cm2; median, 1.05 cm2; range (0.45-2.30)], P=0.87; r=0.79, P<0.0001; ICC=0.79) and mean difference between methods was small (+0.004±0.21 cm2). MVA3D measured by the non-experienced operator [1.08±0.34 cm2; median 1.02 cm2; range (0.45-2.23)] also did not differ from and correlated well with MVA2D measured by experienced operators (P=0.25; r=0.86, P<0.0001; mean difference -0.02±0.18 cm2; ICC=0.86). Intra and interobserver variability were 0.02±0.25 and 0.01±0.33 cm2. 3D-TEE provides accurate and reproducible MVA measurements similar to 2D planimetry performed by experienced operators. Thus, 3D-TEE could be considered as a second-line alternative tool for the evaluation of MS severity in patients with poor echocardiographic windows or for team less accustomed to evaluate MS patients.

Real-time 3D transoesophageal echocardiography evaluation of the mitral valve area in patients with mitral stenosis

Real-time 3D transoesophageal echocardiography evaluation of the mitral valve area in patients with mitral stenosis