Norum Ingvild Billehaug, Edvardsen Thor, Ruddox Vidar, Gunther Anne, Dahle Gry, Otterstad Jan Erik
Department of Cardiology, Vestfold Hospital trust, Tonsberg, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Scand Cardiovasc J. 2020 Aug;54(4):220-226. doi: 10.1080/14017431.2020.1761559. Epub 2020 May 15.
In grading of aortic stenosis, two-dimensional transthoracic echocardiography (2D TTE) routinely results in underestimation of the left ventricular outflow tract (LVOT) area, and hence the aortic valve area (AVA). We investigated whether three-dimensional (3D) TTE measurements of the LVOT would be more accurate. We evaluated the feasibility, agreement and inter-observer variability of 3D TTE LVOT measurements with computed tomography (CT) and Haegar sizers as reference. Sixty-one patients with severe aortic stenosis were examined with 2D and 3D TTE. 41 had CT and 13 also had perioperative Haegar sizing. Pearson's correlation and Bland-Altman plots were used to compare methods. Inter-observer variability was tested for 2D and 3D TTE. Trial registration: Current research information system in Norway (CRISTIN). Id: 555249. Feasibility was 67% with 3D TTE and 100% with 2D TTE and CT. Mean LVOT area for 2D, 3D, CT and Haegar sizers were 3.7 ± 0.6 cm2, 4.0 ± 0.9 cm2, 5.2 ± 0.8 cm2 and 4.4 ± 1.0 cm2 respectively. Bias and limits of agreements for 2D TTE was 1.5 ± 1.3 cm2, compared with CT and 0.4 ± 1.5 cm2 with Haegar sizers. Corresponding results for 3D TTE were 1.2 ± 1.6 cm2 and 0.2 ± 1.8 cm2. Intraclass correlation coefficients for LVOT area were 0.62 for 3D and 0.86 for 2D. 2D TTE showed better feasibility and inter-observer variability in measurements of LVOT than 3D TTE. Both echocardiographic methods underestimated LVOT area compared to CT and Haegar sizers. These observations suggest that 2D TTE is still preferable to 3D TTE in the assessment of aortic stenosis.
在评估主动脉瓣狭窄时，二维经胸超声心动图（2D TTE）常常会低估左心室流出道（LVOT）面积，进而低估主动脉瓣面积（AVA）。我们研究了三维（3D）TTE测量LVOT是否会更准确。我们以计算机断层扫描（CT）和黑格测量器作为参考，评估了3D TTE测量LVOT的可行性、一致性及观察者间的变异性。对61例重度主动脉瓣狭窄患者进行了2D和3D TTE检查。41例患者接受了CT检查，13例患者还进行了围手术期黑格测量。采用Pearson相关性分析和Bland-Altman图比较不同方法。对2D和3D TTE测量的观察者间变异性进行了检测。试验注册：挪威当前研究信息系统（CRISTIN）。编号：555249。3D TTE的可行性为67%，2D TTE和CT的可行性为100%。2D、3D、CT及黑格测量器测量的LVOT平均面积分别为3.7±0.6cm²、4.0±0.9cm²、5.2±0.8cm²和4.4±1.0cm²。与CT相比，2D TTE的偏差及一致性界限为1.5±1.3cm²，与黑格测量器相比为0.4±1.5cm²。3D TTE的相应结果分别为1.2±1.6cm²和0.2±1.8cm²。LVOT面积的组内相关系数3D为0.62，2D为0.86。与3D TTE相比，2D TTE在测量LVOT时显示出更好的可行性和观察者间变异性。与CT和黑格测量器相比，两种超声心动图方法均低估了LVOT面积。这些观察结果表明，在评估主动脉瓣狭窄时，2D TTE仍优于3D TTE。
