Papadopoulos Konstantinos, Ikonomidis Ignatios, Özden Özge, Tzikas Apostolos, Arampatzis Chourmouzios A, Vannan Manni A
Echocardiography Laboratory, European Interbalkan Medical Center, Thessaloniki, Greece.
Echocardiography Laboratory, 2nd Cardiology Department, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
Echocardiography. 2022 Dec;39(12):1512-1521. doi: 10.1111/echo.15481. Epub 2022 Nov 9.
Mitral annulus assessment is of utmost importance for the management of patients with mitral valve (MV) abnormalities, as it helps to determine the decision for surgical or transcatheter treatment. Three-dimensional (3D) transesophageal echocardiography (TOE) has been the only reliable echocardiographic method for the evaluation of the mitral annulus by now. However, newer transthoracic echocardiography (TTE) 3D probes have enabled to provide accurate measurements as well and become a valuable tool when TOE is contraindicated. The aim of this study is to assess the feasibility of 3D TTE analysis of mitral annulus and the level of agreement with 3D TOE measurements.
A total of 121 consecutive patients were assessed with 3D TTE and TOE. All mitral annulus parameters were retrospectively analyzed with the dedicated 4D autoMVQ application. Bland-Altman analysis and intraclass correlation coefficient were used for the comparison and agreement between the two methods. Half of our patients had normal mitral valves and served as control group, while the other half had various mitral valve pathologies.
AutoMVQ analysis was not feasible in 11 out of 121 TTE examinations (91% feasibility) and in 4 out of 121 TOE examinations (96% feasibility). Mitral annular area and perimeter were slightly larger in TTE than those measured by TOE (12.7 ± 3.6 vs. 12.4 ± 3.2 cm for area and 12.7 ± 1.7 vs. 12.5 ± 1.6 cm for perimeter), however still showing strong correlation (r = .942 and r = .922, respectively). The majority of mitral valve measurements (anterior-posterior, medial-lateral and commissural diameter, aorto-mitral angle and anterior leaflet length) were similar among the two methods with strong correlation (r > .80). Inter-trigonal distance, posterior leaflet length and tenting height showed weaker agreement between TTE and TOE (r = .687, r = .687, r = .634, respectively). Mitral annular dimensions (by 3D area) were found to be significantly larger in patients with MV pathology (13.5 ± 3.5 vs. 11 ± 2.3 cm ), atrial fibrillation (14.4 ± 3 vs. 11.4 ± 2.8 cm ), left ventricular (13.8 ± 3.1 vs. 11.7 ± 3.1cm ) and left atrial dilatation (13 ± 3.3 vs. 10.6 ± 2.3cm ) compared to the individuals in the control group (p < .001 for all comparisons).
Assessment of the MV with 3D TTE with dedicated MVQ software is feasible and accurate, showing strong correlation and agreement with TOE measurements.
二尖瓣环评估对于二尖瓣（MV）异常患者的管理至关重要，因为它有助于确定手术或经导管治疗的决策。三维（3D）经食管超声心动图（TOE）是目前评估二尖瓣环唯一可靠的超声心动图方法。然而，新型经胸超声心动图（TTE）3D探头也能够提供准确测量，并且在TOE禁忌时成为一种有价值的工具。本研究的目的是评估二尖瓣环3D TTE分析的可行性以及与3D TOE测量的一致性水平。
连续121例患者接受了3D TTE和TOE评估。所有二尖瓣环参数均使用专用的4D autoMVQ应用程序进行回顾性分析。采用Bland-Altman分析和组内相关系数来比较两种方法并评估一致性。我们一半的患者二尖瓣正常，作为对照组，另一半有各种二尖瓣病变。
121例TTE检查中有11例（可行性91%）和121例TOE检查中有4例（可行性96%）无法进行AutoMVQ分析。TTE测量的二尖瓣环面积和周长略大于TOE测量值（面积分别为12.7±3.6 vs. 12.4±3.2 cm，周长分别为12.7±1.7 vs. 12.5±1.6 cm），但仍显示出强相关性（分别为r =.942和r =.922）。两种方法测量的大多数二尖瓣参数（前后径、内外径、瓣环直径、主动脉-二尖瓣夹角和前叶长度）相似，相关性强（r>.80）。TTE和TOE之间的三角间距、后叶长度和帐篷高度一致性较弱（分别为r =.687、r =.687、r =.634）。与对照组相比，MV病变（13.5±3.5 vs. 11±2.3 cm）、心房颤动（AF）（14.4±3 vs. 11.4±2.8 cm）、左心室扩张（13.8±3.1 vs. 11.7±3.1 cm）和左心房扩张（13±3.3 vs. 10.6±2.3 cm）患者的二尖瓣环尺寸（通过3D面积）明显更大（所有比较p<.001）。
使用专用MVQ软件的3D TTE评估MV是可行且准确的，与TOE测量显示出强相关性和一致性。
