Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece.
Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece.
J Am Soc Echocardiogr. 2022 Dec;35(12):1273-1280. doi: 10.1016/j.echo.2022.08.012. Epub 2022 Sep 2.
The aim of this study was to evaluate the ability of a novel handheld echocardiography (HHE) device with continuous-wave Doppler (CWD) capability to measure aortic valve peak jet velocity (Vmax) and facilitate aortic stenosis (AS) severity grading.
One hundred twenty-one consecutive patients with known or suspected AS were prospectively included. All patients were scanned with the HHE device and a high-end echocardiography system (the reference standard) to obtain CWD signal across the aortic valve. Aortic Vmax measurements were acquired from the apical five-chamber view using both methods and were compared to assess method agreement using the intraclass correlation coefficient, linear regression analysis, and Bland-Altman analysis. Diagnostic accuracy for the detection of at least moderate AS (Vmax ≥ 3 m/sec) was calculated. Also, the utility of HHE with CWD to reclassify patients compared with the visual estimation of AS severity was assessed.
The acquisition of CWD signal using HHE was feasible in 118 of 121 patients (mean age, 68 ± 17 years; 57% men). There was excellent agreement between the HHE CWD and the cart-based measurements (intraclass correlation coefficient = 0.97 [95% CI: 0.83-0.99] and r = 0.98 [95% CI: 0.91-0.99], P < .001 for both). The Bland-Altman plot showed a small underestimation bias of -0.2 m/sec (P < .001), with limits of agreement ±0.44 m/sec for Vmax. Detection of at least moderate AS using HHE with CWD was feasible with sensitivity of 93% (95% CI: 83%-98%), specificity of 98% (95% CI: 91%-100%), positive predictive value of 98% (95% CI: 88%-100%), negative predictive value of 94% (95% CI: 85%-97%), and total diagnostic accuracy of 96%. Patients visually assessed as having mild AS were reclassified as having no stenosis (17%), mild AS (72%), or moderate AS (11%) with the addition of CWD imaging.
Use of a novel HHE device with CWD spectral analysis by experienced operators can reliably detect clinically significant AS and facilitate AS grading. This technology may improve screening and diagnostic workup of AS compared with current practice.
本研究旨在评估一种新型手持超声心动图（HHE）设备结合连续波多普勒（CWD）功能测量主动脉瓣峰值射流速度（Vmax）的能力，并有助于评估主动脉瓣狭窄（AS）的严重程度。
连续纳入 121 例已知或疑似 AS 的患者进行前瞻性研究。所有患者均使用 HHE 设备和高端超声心动图系统（参考标准）进行扫描，以获取主动脉瓣的 CWD 信号。使用两种方法从心尖五腔心切面获取主动脉 Vmax 测量值，并通过组内相关系数、线性回归分析和 Bland-Altman 分析评估方法间的一致性。计算用于检测至少中度 AS（Vmax≥3m/s）的诊断准确性。还评估了 HHE 结合 CWD 与视觉估计 AS 严重程度相比重新分类患者的效用。
在 121 例患者中，有 118 例（平均年龄 68±17 岁；57%为男性）成功获得了 HHE 的 CWD 信号。HHE CWD 与基于 cart 的测量结果具有极好的一致性（组内相关系数为 0.97[95%CI：0.83-0.99]，r=0.98[95%CI：0.91-0.99]，P均<.001）。Bland-Altman 图显示出低估的小偏差，为-0.2m/s（P<.001），Vmax 的一致性界限为±0.44m/s。使用 HHE 结合 CWD 检测至少中度 AS 的灵敏度为 93%（95%CI：83%-98%），特异性为 98%（95%CI：91%-100%），阳性预测值为 98%（95%CI：88%-100%），阴性预测值为 94%（95%CI：85%-97%），总诊断准确性为 96%。使用 CWD 成像后，经视觉评估为轻度 AS 的患者被重新分类为无狭窄（17%）、轻度 AS（72%）或中度 AS（11%）。
使用经验丰富的操作人员的新型 HHE 设备结合 CWD 光谱分析可以可靠地检测出有临床意义的 AS，并有助于评估 AS 的严重程度。与目前的实践相比，该技术可能会改善 AS 的筛查和诊断。
