Hafiz Abdul Moiz, Medranda Giorgio A, Kakouros Nikolaos, Patel Jay, Kahan Jonathan, Gubernikoff George, Ray Beevash, Paruchuri Vijayapraveena, DeLeon Joshua, Marzo Kevin, Calixte Rose, Gaztanaga Juan
University of Massachusetts Medical School, Worcester, MA, USA.
NYU Winthrop Hospital, Mineola, NY, USA.
Echocardiography. 2017 Aug;34(8):1195-1202. doi: 10.1111/echo.13613. Epub 2017 Jul 18.
The role of three-dimensional transesophageal echocardiography (3DTEE) vs multidetector computed tomography (MDCT) in aortic annular sizing has been poorly defined in patients undergoing transcatheter aortic valve replacements (TAVR). We set to determine the correlation between 3DTEE and MDCT in measuring the aortic annulus prior to TAVR.
In an observational, retrospective study, we compared aortic annular areas measured by MDCT and 3DTEE in TAVR patients. The aortic annular area was measured by planimetry of images obtained by MDCT pre-TAVR and by intra-TAVR TEE using 3D rendering of the aortic annulus followed by planimetry. Our primary outcome was degree of correlation between mean aortic annulus area by 3DTEE and MDCT.
Of the 111 consecutive patients undergoing TAVR who had measurements from both modalities available for comparison between February 2012 and April 2015, 87 met inclusion criteria. The mean aortic annular area by MDCT was 4.44±0.88 cm and by 3DTEE was 4.33±0.78 cm . There was a strong positive linear correlation between aortic annular area measurements obtained from these two modalities with mild relative underestimation by 3DTEE (ρ=.833). This relationship can be estimated using the predictive formula: [Formula: see text] CONCLUSIONS: Three-dimensional transesophageal echocardiography measurements have a high degree of correlation with MDCT measurements and thus can assist in proper valve prosthesis selection for TAVR. Our study thus supports use of 3DTEE as a reasonable alternative imaging modality in patients undergoing TAVR.
在接受经导管主动脉瓣置换术（TAVR）的患者中，三维经食管超声心动图（3DTEE）与多排螺旋计算机断层扫描（MDCT）在主动脉瓣环尺寸测量方面的作用尚未明确界定。我们旨在确定TAVR术前3DTEE与MDCT在测量主动脉瓣环方面的相关性。
在一项观察性回顾性研究中，我们比较了TAVR患者中MDCT和3DTEE测量的主动脉瓣环面积。通过MDCT术前图像的面积测量法以及TAVR术中经食管超声心动图（TEE）对主动脉瓣环进行三维重建后再行面积测量法来测量主动脉瓣环面积。我们的主要结局是3DTEE和MDCT测得的平均主动脉瓣环面积之间的相关程度。
在2012年2月至2015年4月期间连续接受TAVR且两种测量方法均可用于比较的111例患者中，87例符合纳入标准。MDCT测得的平均主动脉瓣环面积为4.44±0.88平方厘米，3DTEE测得的为4.33±0.78平方厘米。这两种测量方法测得的主动脉瓣环面积之间存在强正线性相关性，3DTEE有轻度相对低估（ρ=0.833）。这种关系可用预测公式估算：[公式：见原文] 结论：三维经食管超声心动图测量结果与MDCT测量结果高度相关，因此可为TAVR患者选择合适的瓣膜假体提供帮助。我们的研究因此支持将3DTEE作为接受TAVR患者的一种合理的替代成像方式。
