Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
J Am Soc Echocardiogr. 2017 Jul;30(7):625-635. doi: 10.1016/j.echo.2017.03.006. Epub 2017 May 10.
Ascending aorta dilatation is common in bicuspid aortic valve (BAV). The aim of this study was to investigate agreement of transthoracic echocardiographic (TTE) measurement of the sinuses of Valsalva and the tubular mid-ascending aorta (Asc-Ao) compared with electrocardiographically gated computed tomographic angiographic (CTA) assessment in patients with BAV.
Fifty-three patients with BAV (mean age, 54 ± 14 years; 74% men) who underwent both TTE and CTA imaging for ascending aortic assessment were retrospectively identified. All studies were measured de novo by experts. TTE measurements were obtained at the sinuses and the Asc-Ao, at both systole and end-diastole, using both leading edge-to-leading edge (L-L) and inner edge-to-inner edge (I-I) methods in the parasternal long-axis (LAX) view. The sinuses were also measured in the parasternal short-axis (SAX) view using the same methods plus mid-diastole. CTA measurements were obtained in diastole using outer wall-to-outer wall (O-O) and inner wall-to-inner wall (I-I) methods. Correlation and agreement between the two imaging modalities were assessed using Lin correlation and Bland-Altman analysis, respectively.
Compared with CTA O-O maximum sinuses diameter, the best correlation and agreement were obtained using the TTE SAX mid-diastolic L-L method (ρ = 0.89, 2.6 ± 2.3 mm, respectively). Compared with CTA O-O maximum Asc-Ao diameter, the TTE LAX systolic L-L method (ρ = 0.93, 1.3 ± 2.5 mm) was best. Compared with CTA I-I maximum sinuses diameter, the TTE SAX mid-diastole L-L method (ρ = 0.95, 0.6 ± 2.2 mm) was unbiased. Compared with CTA I-I maximum Asc-Ao diameter, the TTE LAX end-diastolic L-L method (ρ = 0.95, 0.6 ± 2.4 mm) was unbiased.
In patients with BAV aortopathy, unbiased agreement between CTA and TTE imaging can be obtained between the CTA I-I method and TTE SAX mid-diastolic L-L method for the sinuses and the TTE LAX end-diastolic L-L method for the Asc-Ao. When using the CTA O-O method, the best agreement is obtained with the TTE SAX mid-diastolic L-L method for the sinuses (bias ∼2 mm) and the TTE LAX systolic L-L method (bias ∼1 mm) for the Asc-Ao.
升主动脉扩张在二叶式主动脉瓣（BAV）中很常见。本研究旨在探讨经胸超声心动图（TTE）测量窦部和升主动脉中段（Asc-Ao）与心电图门控计算机断层血管造影（CTA）评估在 BAV 患者中的一致性。
回顾性分析 53 例接受 TTE 和 CTA 评估升主动脉的 BAV 患者（平均年龄 54±14 岁，74%为男性）。所有研究均由专家进行新的测量。TTE 测量在窦性和 Asc-Ao 中进行，在胸骨旁长轴（LAX）视图中使用前缘到前缘（L-L）和内缘到内缘（I-I）方法，在收缩期和舒张末期进行测量。窦部也使用相同的方法在胸骨旁短轴（SAX）视图中测量，并在舒张中期测量。CTA 测量在舒张期使用外壁到外壁（O-O）和内壁到内壁（I-I）方法进行。使用 Lin 相关和 Bland-Altman 分析分别评估两种成像方式之间的相关性和一致性。
与 CTA O-O 最大窦部直径相比，TTE SAX 舒张中期 L-L 方法获得了最佳的相关性和一致性（ρ=0.89，2.6±2.3mm）。与 CTA O-O 最大 Asc-Ao 直径相比，TTE LAX 收缩期 L-L 方法（ρ=0.93，1.3±2.5mm）最好。与 CTA I-I 最大窦部直径相比，TTE SAX 舒张中期 L-L 方法（ρ=0.95，0.6±2.2mm）无偏差。与 CTA I-I 最大 Asc-Ao 直径相比，TTE LAX 舒张末期 L-L 方法（ρ=0.95，0.6±2.4mm）无偏差。
在 BAV 主动脉病变患者中，当使用 CTA O-O 方法时，使用 TTE SAX 舒张中期 L-L 方法测量窦部（偏差约 2mm）和 TTE LAX 收缩期 L-L 方法测量 Asc-Ao（偏差约 1mm）时，CTA 和 TTE 成像之间可以获得 CTA I-I 方法与 TTE SAX 舒张中期 L-L 方法之间的无偏差一致性。
