Adult Cardiology department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt.
Cardiology department, Aswan University, Aswan, Egypt.
Echocardiography. 2024 Mar;41(3):e15785. doi: 10.1111/echo.15785.
Trans-catheter mitral valve replacement (TMVR) procedures had emerged as an alternative solution for patients who are at high risk for mitral valve surgery. Although cardiac computed tomography (CT) remains the standard method for procedural planning, there is no full agreement on the best systolic phase for quantitation of the neoLVOT. Furthermore, a new three-dimensional trans-esophageal echocardiography (3DTEE) based software was developed to serve as filter and or an alternative for patients who cannot have CT due to any contraindication.
To determine the systolic phase of the cardiac cycle that shows the narrowest NeoLVOT area in order to standardize the way of using these software and then to validate the 3DTEE-based software against the CT-based one as a gold standard, in mitral valve annulus (MA) and NeoLVOT assessment.
A single center, observational, retrospective study. Initially, a sample of 20 patients (age 62 ± 4 years, 70% men) had CT-based analysis at mid-diastole (80%), early-systole (10%), mid-systole (20%), late-systole (30%-40%), in order to detect the best systolic phase at which the neoLVOT area is the narrowest after TMVR. Then, the end systolic phase was standardized for the analysis of 49 patients (age 57 ± 6 years, 60% men), using both the commercially available CT-based software and the newly available 3DTEE-based software (3mensio Structural Heart, Pie Medical Imaging, The Netherlands). The 3DTEE derived parameters were compared with the gold standard CT-based measurements.
The neoLVOT area was significantly narrower at end-systole (224 ± 62 mm), compared to early-systole (299 ± 70 mm) and mid-systole (261 ± 75 mm), (p = .005). Excellent correlation was found between 3DTEE and CT measurements for MA AP diameter (r = .96), IC diameter (r = .92), MA area (r = .96), MA perimeter (r = .94) and NeoLVOT area (r = .96), (all p-values < .0001). Virtual valve sizing was based on annulus measurement and was identical between CT and 3DTEE. Interobserver and intraobserver agreements were excellent for all the measurements with ICCs > .80.
End-systole is the phase that shows the narrowest neoLVOT and hence should be the standard phase used during the analysis. The 3DTEE based analysis using this new software is reliable compared to the CT-based analysis and can be serve as an alternative analysis tool in patients who cannot have CT for any clinical contraindication or as a screening test and/or filter for all patients before proceeding to a detailed CT scan.
经导管二尖瓣置换术（TMVR）已成为高危二尖瓣手术患者的替代治疗方案。尽管心脏计算机断层扫描（CT）仍然是手术规划的标准方法，但对于定量测量新左心室流出道（NeoLVOT）的最佳收缩期相位，尚未达成完全共识。此外，已经开发出一种新的基于三维经食管超声心动图（3DTEE）的软件，以作为无法进行 CT 检查的患者的过滤器或替代方法，因为存在任何禁忌症。
确定显示新左心室流出道最小面积的心动周期收缩期相位，以标准化这些软件的使用方式，然后将基于 3DTEE 的软件与基于 CT 的软件作为金标准进行验证，用于二尖瓣环（MA）和新左心室流出道评估。
这是一项单中心、观察性、回顾性研究。最初，对 20 名患者（年龄 62±4 岁，70%为男性）进行 CT 基于中舒张期（80%）、早期收缩期（10%）、中期收缩期（20%）、晚期收缩期（30%-40%）的分析，以检测 TMVR 后新左心室流出道面积最窄的最佳收缩期相位。然后，使用商业上可用的 CT 基于软件和新的可用 3DTEE 基于软件（3mensio Structural Heart，Pie Medical Imaging，荷兰）对 49 名患者（年龄 57±6 岁，60%为男性）的终末收缩期相位进行标准化分析。将 3DTEE 衍生参数与金标准 CT 测量值进行比较。
与早期收缩期（299±70mm）和中期收缩期（261±75mm）相比，新左心室流出道面积在终末收缩期显著更窄（224±62mm），差异具有统计学意义（p=0.005）。3DTEE 与 CT 测量的 MA AP 直径（r=0.96）、IC 直径（r=0.92）、MA 面积（r=0.96）、MA 周长（r=0.94）和新左心室流出道面积（r=0.96）之间存在极好的相关性，（所有 p 值均<.0001）。虚拟瓣膜大小基于瓣环测量，CT 和 3DTEE 相同。所有测量的观察者间和观察者内一致性均极好，ICC>0.80。
收缩末期是显示新左心室流出道最窄的相位，因此应该是分析时的标准相位。与 CT 基于分析相比，基于 3DTEE 的分析是可靠的，并且可以作为无法进行 CT 的患者的替代分析工具，或者作为所有患者在进行详细 CT 扫描之前的筛选测试和/或过滤器。
