Tsang Wendy, Bateman Michael G, Weinert Lynn, Pellegrini Gian, Mor-Avi Victor, Sugeng Lissa, Yeung Hubert, Patel Amit R, Hill Alexander J, Iaizzo Paul A, Lang Roberto M
Department of Cardiology, University of Chicago, D5841 South Maryland Avenue, Chicago, IL 60637, USA.
Heart. 2012 Aug;98(15):1146-52. doi: 10.1136/heartjnl-2012-302074.
To determine the accuracy of calcium-containing rings measurements imaged by three-dimensional echocardiography (3DE), multi-slice CT (MSCT) and cardiac magnetic resonance (CMR) under ideal conditions against the true ring dimensions. To compare the accuracy of aortic annulus (AoA) measurements in ex vivo human hearts using 3DE, MSCT and CMR. To determine the accuracy of AoA measurements in an in vivo human model.
3DE, MSCT and CMR imaging were performed on 30 calcium-containing rings and 28 explanted human hearts. Additionally, 15 human subjects with clinical indication for MSCT underwent 3DE. Two experts in each modality measured the images.
Bias and intraclass correlation coefficient for accuracy of imaging measurements when compared with actual ring dimensions. Bias, intraclass correlation coefficient and variability were obtained: (1) when comparing explanted human heart AoA measurements from the two remaining imaging modalities with the most accurate one as determined from the ring measurements and (2) in in vivo human AoA measurements. Analysis was repeated on explanted heart subgroups divided by aortic valve Agatston score.
Against the known ring dimensions, CMR had the highest accuracy and the lowest variability. MSCT measurements had high accuracy but wider variability and 3DE had the lowest accuracy with the largest variability. When 3DE and MSCT were compared with CMR, 3DE underestimated and MSCT overestimated AoA dimensions, but inter-measurement variability of 3DE and MSCT were similar. When divided by Agatston score, both 3DE and MSCT measurements were larger and showed greater variability with increasing calcium burden. The in vivo study showed that the correlation between 3DE and MSCT measurements was high; however, 3DE measurements were smaller than those measured with MSCT.
In the in vitro model, CMR measurements were the most accurate for assessing the actual dimensions suggesting that further investigations on its role in AoA measurement in TAVR are needed. However from the in vivo model, MSCT and 3DE are reasonable alternatives with the understanding that they can slightly overestimate and underestimate annular dimensions, respectively.
在理想条件下，确定三维超声心动图（3DE）、多层螺旋CT（MSCT）和心脏磁共振成像（CMR）对含钙化环测量的准确性，并与真实环尺寸进行对比。比较3DE、MSCT和CMR在离体人心脏中测量主动脉瓣环（AoA）的准确性。确定在体内人体模型中测量AoA的准确性。
对30个含钙化环和28个离体人心脏进行3DE、MSCT和CMR成像。另外，15名有MSCT临床指征的受试者接受了3DE检查。每种成像方式由两名专家测量图像。
与实际环尺寸相比，成像测量准确性的偏差和组内相关系数。获得偏差、组内相关系数和变异性：（1）将两种剩余成像方式对离体人心脏AoA的测量结果与根据环测量确定的最准确测量结果进行比较时；（2）在体内人体AoA测量中。对根据主动脉瓣阿加特森评分划分的离体心脏亚组重复进行分析。
与已知的环尺寸相比，CMR准确性最高，变异性最低。MSCT测量准确性高，但变异性较大，3DE准确性最低，变异性最大。当将3DE和MSCT与CMR比较时，3DE低估了AoA尺寸，MSCT高估了AoA尺寸，但3DE和MSCT的测量间变异性相似。根据阿加特森评分划分时，随着钙负荷增加，3DE和MSCT测量值均更大，且变异性更大。体内研究表明，3DE和MSCT测量值之间的相关性较高；然而，3DE测量值小于MSCT测量值。
在体外模型中，CMR测量对于评估实际尺寸最为准确，这表明需要进一步研究其在经导管主动脉瓣置换术（TAVR）中AoA测量中的作用。然而，从体内模型来看，MSCT和3DE是合理的替代方法，但要明白它们可能分别略微高估和低估瓣环尺寸。
