Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
Eur Heart J Cardiovasc Imaging. 2023 Jul 24;24(8):1043-1051. doi: 10.1093/ehjci/jead015.
The procedural planning of transcatheter mitral valve replacement (TMVR) requires a specific imaging assessment to establish patient eligibility. Computed tomography (CT) is considered the reference method. In this setting, data regarding the role of transoesophageal echocardiography (TOE) are lacking. We evaluated the feasibility and reliability of a comprehensive 3D-TOE screening in TMVR candidates.
We performed a retrospective observational study including 72 consecutive patients who underwent a pre-procedural CT and 3D-TOE for TMVR evaluation. The measurements of mitral annulus (MA), length of anterior mitral leaflet (AML), native left ventricular outflow tract (LVOT), and predicted neo-LVOT acquired with CT and 3D-TOE were compared using a novel semi-automated software for post processing analysis (3 mensio Structural Heart 10.1-3mSH, Pie Medical Imaging, Bilthoven, Netherlands). The final suitability decision was given by the valve manufacturer based on CT measurements and clinical conditions. Among 72 patients screened, all patients had adequate image quality for 3D-TOE analysis. 3D-TOE and CT measurements for AML length (r = 0.97), MA area (r = 0.90), perimeter (r = 0.68), anteroposterior (r = 0.88), and posteromedial-anterolateral (r = 0.74) diameters were found highly correlated, as well as for native LVOT (r = 0.86) and predicted neo-LVOT areas (r = 0.96) (all P-values <0.0001). An almost perfect agreement between CT and 3DTOE was found in assessing the eligibility for TMVR implantation (Cohen kappa 0.83, P < 0.001).
3D-TOE appraisements showed good correlations with CT measurements and high accuracy to predict TMVR screening success.
经导管二尖瓣置换术（TMVR）的程序规划需要特定的影像学评估来确定患者的适应证。计算机断层扫描（CT）被认为是参考方法。在这种情况下，关于经食管超声心动图（TOE）作用的数据缺乏。我们评估了在 TMVR 候选者中进行全面的 3D-TOE 筛查的可行性和可靠性。
我们进行了一项回顾性观察研究，纳入了 72 例连续接受 TMVR 评估的患者，他们均进行了术前 CT 和 3D-TOE 检查。使用新型的后处理分析半自动化软件（3mensio Structural Heart 10.1-3mSH，Pie Medical Imaging，荷兰比勒陀利亚）比较了 CT 和 3D-TOE 测量的二尖瓣环（MA）、前二尖瓣叶（AML）长度、固有左心室流出道（LVOT）和预测的 neo-LVOT。最终适应证决策由瓣膜制造商根据 CT 测量和临床情况做出。在筛选的 72 例患者中，所有患者的 3D-TOE 分析均具有足够的图像质量。3D-TOE 和 CT 测量的 AML 长度（r = 0.97）、MA 面积（r = 0.90）、周长（r = 0.68）、前后径（r = 0.88）和后内侧-前外侧径（r = 0.74）直径高度相关，固有 LVOT（r = 0.86）和预测的 neo-LVOT 面积（r = 0.96）也高度相关（所有 P 值均<0.0001）。CT 和 3DTOE 在评估 TMVR 植入的适应证方面几乎完全一致（Cohen kappa 0.83，P <0.001）。
3D-TOE 评估与 CT 测量具有良好的相关性，并且可以高度准确地预测 TMVR 筛查的成功。
