Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Int J Cardiol. 2019 Feb 1;276:230-235. doi: 10.1016/j.ijcard.2018.08.067. Epub 2018 Aug 24.
No established reference-standard technique is available for ascending aortic diameter measurements. The aim of this study was to determine agreement between modalities and techniques.
In patients with aortic pathology transthoracic echocardiography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) were performed. Aortic diameters were measured at the sinus of Valsalva (SoV), sinotubular junction (STJ) and tubular ascending aorta (TAA) during mid-systole and end-diastole. In echocardiography both the inner edge-to-inner edge (I-I edge) and leading edge-to‑leading edge (L-L edge) methods were applied, and the length of the aortic annulus to the most cranial visible part of the ascending aorta was measured. In CTA and MRA the I-I method was used.
Fifty patients with bicuspid aortic valve (36 ± 13 years, 26% female) and 50 Turner patients (35 ± 13 years) were included. Comparison of all aortic measurements showed a mean difference of 5.4 ± 2.7 mm for the SoV, 5.1 ± 2.0 mm for the STJ and 4.8 ± 2.1 mm for the TAA. The maximum difference was 18 mm. The best agreement was found between echocardiography L-L edge and CTA during mid-systole. CTA and MRA showed good agreement. A mean difference of 1.5 ± 1.3 mm and 1.8 ± 1.5 mm was demonstrated at the level of the STJ and TAA comparing mid-systolic with end-diastolic diameters. The visible length of the aorta increased on average 5.3 ± 5.1 mmW during mid-systole.
MRA and CTA showed best agreement with L-L edge method by echocardiography. In individual patients large differences in ascending aortic diameter were demonstrated, warranting measurement standardization. The use of CTA or MRA is advised at least once.
目前尚无测量升主动脉直径的既定参考标准技术。本研究旨在确定不同模态和技术之间的一致性。
在主动脉病变患者中，进行了经胸超声心动图、计算机断层血管造影术（CTA）和磁共振血管造影术（MRA）检查。在心脏收缩中期和舒张末期测量窦部（SoV）、窦管交界（STJ）和升主动脉管腔（TAA）的主动脉直径。在超声心动图中，分别应用内缘到内缘（I-I 边缘）和前缘到前缘（L-L 边缘）方法，并测量主动脉瓣环到升主动脉最颅侧可见部分的长度。在 CTA 和 MRA 中使用 I-I 方法。
共纳入 50 例二叶式主动脉瓣患者（36±13 岁，26%为女性）和 50 例 Turner 综合征患者（35±13 岁）。所有主动脉测量值的比较显示，SoV 的平均差异为 5.4±2.7mm，STJ 的平均差异为 5.1±2.0mm，TAA 的平均差异为 4.8±2.1mm。最大差异为 18mm。在心脏收缩中期，超声心动图 L-L 边缘与 CTA 的一致性最好。CTA 和 MRA 显示出良好的一致性。STJ 和 TAA 处，与收缩中期相比，舒张末期直径的平均差异为 1.5±1.3mm 和 1.8±1.5mm。在心脏收缩中期，主动脉的可视长度平均增加 5.3±5.1mm。
MRA 和 CTA 与超声心动图的 L-L 边缘方法具有最佳一致性。在个别患者中，升主动脉直径存在较大差异，需要进行测量标准化。建议至少使用一次 CTA 或 MRA。
