Department of Cardiology, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland.
Int J Cardiovasc Imaging. 2012 Feb;28(2):343-52. doi: 10.1007/s10554-010-9784-z. Epub 2011 Jan 30.
Precise measurements of aortic complex diameters are essential for preoperative examinations of patients with aortic stenosis (AS) scheduled for aortic valve (AV) replacement. We aimed to prospectively compare the accuracy of transthoracic echocardiography (TTE), transoesophageal echocardiography (TEE) and multi-slice computed tomography (MSCT) measurements of the AV complex and to analyze the role of the multi-modality aortic annulus diameter (AAd) assessment in the selection of the optimal prosthesis to be implanted in patients surgically treated for degenerative AS. 20 patients (F/M: 3/17; age: 69 ± 6.5 years) with severe degenerative AS were enrolled into the study. TTE, TEE and MSCT including AV calcium score (AVCS) assessment were performed in all patients. The values of AAd obtained in the long AV complex axis (TTE, TEE, MSCT) and in multiplanar perpendicular imaging (MSCT) were compared to the size of implanted prosthesis. The mean AAd was 24 ± 3.6 mm using TTE, 26 ± 4.2 mm using TEE, and 26.9 ± 3.2 in MSCT (P = 0.04 vs. TTE). The mean diameter of the left ventricle out-flow tract in TTE (19.9 ± 2.7 mm) and TEE (19.5 ± 2.7 mm) were smaller than in MSCT (24.9 ± 3.3 mm, P < 0.001 for both). The mean size of implanted prosthesis (22.2 ± 2.3 mm) was significantly smaller than the mean AAd measured by TTE (P = 0.0039), TEE (P = 0.0004), and MSCT (P < 0.0001). The implanted prosthesis size correlated significantly to the AAd: r = 0.603, P = 0.005 for TTE, r = 0.592, P = 0.006 for TEE, and r = 0.791, P < 0.001 for MSCT. Obesity and extensive valve calcification (AV calcium score ≥ 3177Ag.U.) were identified as potent factors that caused a deterioration of both TTE and MSCT performance. The accuracy of AAd measurements in TEE was only limited by AV calcification. In multivariate regression analysis the mean value of the minimum and maximum AAd obtained in MSCT-multiplanar perpendicular imaging was an independent factor (r = 0.802, P < 0.0001) predicting the size of implanted prosthesis. In patients with AS echocardiography remains the main diagnostics tool in clinical practice. MSCT as a 3-dimentional modality allows for accurate measurement of entire AV complex and facilitates optimal matching of prosthesis size.
主动脉瓣复合体（AVC）的精确测量对于计划行主动脉瓣置换术（AVR）的主动脉瓣狭窄（AS）患者的术前检查至关重要。我们旨在前瞻性比较经胸超声心动图（TTE）、经食管超声心动图（TEE）和多层螺旋 CT（MSCT）测量 AVC 的准确性，并分析多模态主动脉瓣环直径（AAd）评估在选择用于退行性 AS 手术治疗患者的最佳假体中的作用。 20 名患者（F/M：3/17；年龄：69 ± 6.5 岁）患有严重退行性 AS 被纳入研究。所有患者均进行 TTE、TEE 和 MSCT 检查，包括 AV 钙评分（AVCS）评估。在长 AVC 轴（TTE、TEE、MSCT）和多平面垂直成像（MSCT）中获得的 AAd 值与植入假体的大小进行比较。使用 TTE 测量的平均 AAd 为 24 ± 3.6mm，TEE 为 26 ± 4.2mm，MSCT 为 26.9 ± 3.2mm（P = 0.04 与 TTE 相比）。TTE（19.9 ± 2.7mm）和 TEE（19.5 ± 2.7mm）测量的左心室流出道直径均小于 MSCT（24.9 ± 3.3mm，均 P < 0.001）。植入假体的平均尺寸（22.2 ± 2.3mm）明显小于 TTE（P = 0.0039）、TEE（P = 0.0004）和 MSCT（P < 0.0001）测量的平均 AAd。植入假体的尺寸与 AAd 呈显著相关：r = 0.603，P = 0.005 用于 TTE，r = 0.592，P = 0.006 用于 TEE，r = 0.791，P < 0.001 用于 MSCT。肥胖和广泛的瓣叶钙化（AV 钙评分≥3177Ag.U.）被确定为导致 TTE 和 MSCT 性能恶化的两个潜在因素。TEE 中 AAd 测量的准确性仅受 AV 钙化的限制。多元回归分析显示，MSCT 多平面垂直成像中获得的最小和最大 AAd 的平均值是预测假体尺寸的独立因素（r = 0.802，P < 0.0001）。在 AS 患者中，超声心动图仍然是临床实践中的主要诊断工具。MSCT 作为一种三维方式，可准确测量整个 AVC，并有助于最佳匹配假体尺寸。
