经胸超声心动图三维手动和半自动软件分析测量主动脉瓣环在经导管主动脉瓣植入术患者中的准确性和可重复性：对假体选择的影响。
Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection.
机构信息
Echocardiography Laboratory, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
Center for Cardiovascular Prevention, San Raffaele University Hospital, Via Olgettina 60, Milan, Italy.
出版信息
Eur Heart J Cardiovasc Imaging. 2019 Jan 1;20(1):45-55. doi: 10.1093/ehjci/jey013.
AIMS
A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced. The system automatically configures a geometric model of the aortic root and performs quantitative analysis of these structures. We compared the measurements of the aortic annulus (AA) obtained by semi-automated 3D-TOE quantitative software and manual analysis vs. multislice computed tomography (MSCT) ones.
METHODS AND RESULTS
One hundred and seventy-five patients (mean age 81.3 ± 6.3 years, 77 men) who underwent both MSCT and 3D-TOE for annulus assessment before transcatheter aortic valve implantation were analysed. Hypothetical prosthetic valve sizing was evaluated using the 3D manual, semi-automated measurements using manufacturer-recommended CT-based sizing algorithm as gold standard. Good correlation between 3D-TOE methods vs. MSCT measurements was found, but the semi-automated analysis demonstrated slightly better correlations for AA major diameter (r = 0.89), perimeter (r = 0.89), and area (r = 0.85) (all P < 0.0001) than manual one. Both 3D methods underestimated the MSCT measurements, but semi-automated measurements showed narrower limits of agreement and lesser bias than manual measurements for most of AA parameters. On average, 3D-TOE semi-automated major diameter, area, and perimeter underestimated the respective MSCT measurements by 7.4%, 3.5%, and 4.4%, respectively, whereas minor diameter was overestimated by 0.3%. Moderate agreement for valve sizing for both 3D-TOE techniques was found: Kappa agreement 0.5 for both semi-automated and manual analysis. Interobserver and intraobserver agreements for the AA measurements were excellent for both techniques (intraclass correlation coefficients for all parameters >0.80).
CONCLUSION
The 3D-TOE semi-automated analysis of AA is feasible and reliable and can be used in clinical practice as an alternative to MSCT for AA assessment.
目的
最近引入了一种经食管三维超声心动图（3D-TOE）重建工具。该系统可自动配置主动脉根部的几何模型，并对这些结构进行定量分析。我们比较了半自动 3D-TOE 定量软件和手动分析与多层螺旋 CT（MSCT）测量的主动脉瓣环（AA）的结果。
方法和结果
分析了 175 例接受经导管主动脉瓣植入术前 MSCT 和 3D-TOE 评估 AA 的患者（平均年龄 81.3±6.3 岁，77 名男性）。使用基于制造商推荐的 CT 大小算法的假设人工瓣膜大小来评估 3D 手动、半自动分析。3D-TOE 方法与 MSCT 测量之间存在良好的相关性，但半自动分析对 AA 大直径（r=0.89）、周长（r=0.89）和面积（r=0.85）的相关性略好（均 P<0.0001）。两种 3D 方法均低估了 MSCT 测量结果，但半自动测量结果的一致性更好，偏差也小于手动测量结果，尤其是对于大多数 AA 参数。平均而言，3D-TOE 半自动大直径、面积和周长分别低估了相应的 MSCT 测量值 7.4%、3.5%和 4.4%，而小直径高估了 0.3%。两种 3D-TOE 技术的瓣膜大小均有中度一致性：半自动和手动分析的 Kappa 一致性均为 0.5。两种技术的 AA 测量的观察者内和观察者间一致性均非常好（所有参数的组内相关系数>0.80）。
结论
AA 的 3D-TOE 半自动分析是可行且可靠的，可作为 MSCT 评估 AA 的替代方法，在临床实践中使用。
Zotero 插件