Elkaryoni Ahmed, Nanda Navin C, Baweja Paramdeep, Arisha Mohammed J, Zamir Harris, Elgebaly Ahmed, Altibi Ahmed Ma, Sharma Rishi
Division of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri.
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
Echocardiography. 2018 Oct;35(10):1626-1634. doi: 10.1111/echo.14147.
Cardiac imaging is the cornerstone of the pretranscatheter aortic valve replacement (TAVR) assessment. Multi-detector computed tomography (MDCT) is considered the conventional imaging modality. However, there is still no definitive gold standard. Targeted cohort of inoperable high-risk patients with underlying comorbidities, particularly renal impairment, makes apparent the need for MDCT alternative. We aimed to demonstrate the correlation extent between MDCT and three-dimensional transesophageal echocardiography (3DTEE) aortic annular area measures and to answer the question: Is 3DTEE a good alternative to MDCT?
A systematic literature search and meta-analysis were conducted to evaluate the degree of correlation and agreement between 3DTEE and MDCT aortic annular sizing. A thorough assessment of EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. All studies comparing 3DTEE and MDCT in relation to aortic annular sizing were included.
Thirteen studies were included (N = 1228 patients). A strong linear correlation was found between 3DTEE and MDCT measurements of aortic annulus area (r = 0.84, P < 0.001), mean perimeter (r = 0. 0.85, P < 0.001), and mean diameter (r = 0.80, P < 0.001). Bland-Altman plots revealed smaller mean 3DTEE values in comparison to MDCT for aortic annular area, the mean difference being -2.22 mm with 95% limits of agreement -12.79 to 8.36.
Aortic annulus measurements obtained by 3DTEE demonstrated a high level of correlation with those evaluated by MDCT. This makes 3DTEE a feasible choice for aortic annulus assessment, with advantage of real time assessment, lack of contrast, and no radiation exposure.
心脏成像检查是经导管主动脉瓣置换术（TAVR）术前评估的基石。多排螺旋计算机断层扫描（MDCT）被视为传统的成像方式。然而，目前仍没有明确的金标准。对于有基础合并症，尤其是肾功能损害的不可手术的高危患者这一特定队列而言，显然需要MDCT的替代方法。我们旨在证明MDCT与三维经食管超声心动图（3DTEE）测量的主动脉瓣环面积之间的相关程度，并回答以下问题：3DTEE是否是MDCT的良好替代方法？
进行了一项系统的文献检索和荟萃分析，以评估3DTEE与MDCT测量主动脉瓣环大小之间的相关程度和一致性。对EMBASE、PubMed和Cochrane对照试验中心注册库（CENTRAL）进行了全面评估。纳入了所有比较3DTEE和MDCT测量主动脉瓣环大小的研究。
共纳入13项研究（N = 1228例患者）。发现3DTEE与MDCT测量的主动脉瓣环面积（r = 0.84，P < 0.001）、平均周长（r = 0.85，P < 0.001）和平均直径（r = 0.80，P < 0.001）之间存在强线性相关性。Bland-Altman图显示，与MDCT相比，3DTEE测量的主动脉瓣环面积的平均数值较小，平均差值为 -2.22 mm，一致性界限为95%（-12.79至8.36）。
3DTEE测量的主动脉瓣环与MDCT评估的结果高度相关。这使得3DTEE成为评估主动脉瓣环的可行选择，其优点是可以实时评估、无需使用造影剂且无辐射暴露。
