Jánosi Rolf Alexander, Kahlert Philipp, Plicht Björn, Wendt Daniel, Eggebrecht Holger, Erbel Raimund, Buck Thomas
Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Germany.
Minim Invasive Ther Allied Technol. 2011 Apr;20(2):85-94. doi: 10.3109/13645706.2011.557385.
We sought to determine the level of agreement and the reproducibility of two-dimensional (2D) transthoracic (2D-TTE), 2D transesophageal (2D-TEE) and real-time three-dimensional (3D) transesophageal echocardiography (RT3D-TEE) for measurement of aortic annulus size in patients referred for transcatheter aortic valve implantation (TAVI). Accurate preoperative assessment of the dimensions of the aortic annulus is critical for patient selection and successful implantation in those undergoing TAVI for severe aortic stenosis (AS). Annulus size was measured using 2D-TTE, 2D-TEE and RT3D-TEE in 105 patients with severe AS referred for TAVI. Agreement between echocardiographic methods and interobserver variability was assessed using the Bland-Altman method and regression analysis, respectively. The mean aortic annuli were 21,7 ± 3 mm measured with 2D-TTE, 22,6 ± 2,8 mm with 2D-TEE and 22,3 ± 2,9 mm with RT3D-TEE. The results showed a small but significant mean difference and a strong correlation between the three measurement techniques (2D-TTE vs. 2D-TEE mean difference 0,84 ± 1,85 mm, r = 0,8, p < 0,0001; 2D-TEE vs. 3D-TEE 0,27 ± 1,14 mm, r = 0,91, p < 0,02; 2D-TTE vs. 3D-TEE 0,58 ± 2,21 mm, r = 0,72, p = 0,02); however, differences between measurements amounted up to 6,1 mm. Interobserver variability for 2D-TTE and 2D-TEE was substantially higher compared with RT3D-TEE. We found significant differences in the dimensions of the aortic annulus measured by 2D-TTE, 2D-TEE and RT3D-TEE. Thus, in patients referred for TAVI, the echocardiographic method used may have an impact on TAVI strategy.
我们试图确定二维经胸超声心动图（2D-TTE）、二维经食管超声心动图（2D-TEE）和实时三维经食管超声心动图（RT3D-TEE）在测量接受经导管主动脉瓣植入术（TAVI）患者主动脉瓣环大小方面的一致性水平和可重复性。对于因严重主动脉瓣狭窄（AS）而接受TAVI的患者，准确的术前主动脉瓣环尺寸评估对于患者选择和成功植入至关重要。对105例因严重AS而接受TAVI的患者，分别使用2D-TTE、2D-TEE和RT3D-TEE测量瓣环大小。分别采用Bland-Altman法和回归分析评估超声心动图方法之间的一致性以及观察者间的变异性。2D-TTE测得的平均主动脉瓣环为21.7±3mm，2D-TEE测得的为22.6±2.8mm，RT3D-TEE测得的为22.3±2.9mm。结果显示，三种测量技术之间存在微小但显著的平均差异和强相关性（2D-TTE与2D-TEE的平均差异为0.84±1.85mm，r = 0.8，p < 0.0001；2D-TEE与3D-TEE为0.27±1.14mm，r = 0.91，p < 0.02；2D-TTE与3D-TEE为0.58±2.21mm，r = 0.72，p = 0.02）；然而，测量值之间的差异高达6.1mm。与RT3D-TEE相比，2D-TTE和2D-TEE的观察者间变异性明显更高。我们发现，2D-TTE、2D-TEE和RT3D-TEE测量的主动脉瓣环尺寸存在显著差异。因此，对于接受TAVI的患者，所使用的超声心动图方法可能会对TAVI策略产生影响。
