Impact of Three-Dimensional Echocardiography on Classification of the Severity of Aortic Stenosis

Jainandunsing, Jayant S.; Mahmood, Feroze; Matyal, Robina; Shakil, Omair; Hess, Philip E.; Lee, Justin; Panzica, Peter; Khabbaz, Kamal R.

doi:10.1016/j.athoracsur.2013.05.018

Cited by 37 publications

(20 citation statements)

References 23 publications

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“…With the advent of 3D imaging techniques, more precise assessment of AVA and LVOT geometry has become possible. Several studies using different 3D imaging modalities, including 3D echocardiography, MDCTA, and cardiac magnetic resonance, have shown that the CE underestimates LVOT area and hence AVA. This could lead to unnecessary referrals for early aortic valve intervention .…”

Section: Discussionmentioning

confidence: 99%

Aortic valve area using computed tomography‐derived correction factor to improve the validity of left ventricular outflow tract measurements

2020

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Aims Given the inherent inaccuracies stemming from the assumption that the left ventricular outflow tract (LVOT) is circular, this study aimed to improve the accuracy of transthoracic echocardiography (TTE)‐based aortic valve area (AVA) calculation using continuity equation (CE) by introducing a correction factor (CF) derived from multidetector computed tomography angiography (MDCTA) images and validate it in aortic stenosis (AS) patients. Methods and Results This retrospective study used MDCTA images of 400 patients for modeling and 403 TTE dataset for validation. Echocardiographic parasternal long‐axis view was modeled using MDCTA, and LVOT diameter (D1) was measured. Direct planimetry of LVOT area was performed and subsequently converted into a theoretical circle. The assumed circle (D2) diameter was derived, and D2/D1 was calculated and termed as the CF. The CF was 1.13, and it improved the agreement between MDCTA‐ and TTE‐derived LVOT areas and correlation between AVA and peak velocity, mean pressure gradient, and velocity ratio. In discordant subgroups of severe AS, the CF reclassified patients to moderate AS in 40% in the low flow (LF), low gradient (LG), and low ejection fraction (EF) group; 53% in the LF, LG, and normal EF group; and 68% in the LF, high gradient, and normal EF group. Conclusions CF of 1.13 derived from MDCTA improved the accuracy of TTE‐derived LVOT area and AVA and improved correlation with hemodynamic variables in AS patients. Reclassification of AS patients using CF may have clinical applicability for patient selection for early intervention.

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Section: Discussionmentioning

confidence: 99%

Aortic valve area using computed tomography‐derived correction factor to improve the validity of left ventricular outflow tract measurements

2020

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“…This has a major impact on the classification of AS severity because many patients thought to have SAS when assuming that the LVOT is circular end up having only moderate AS when measuring the true surface of LVOT by planimetry. [25][26][27] Because the continuity equation-derived AVAs of PLG-SAS are usually comprised between 0.5 and 0.6 cm 2 /m 2 (or between 0.85 and 1 cm 2 ), one should expect their anatomic AVAs to be close to or even >0.6 cm 2 /m 2 when correcting for these measurement errors. This is exactly what we recently reported, using cardiac MR to measure anatomic AVAs.…”

Section: Plg-sas: a Moderate To Severe Form Of Asmentioning

confidence: 99%

Natural History of Paradoxical Low-Gradient Severe Aortic Stenosis

Maes

Boulif

Piérard

et al. 2014

Circ: Cardiovascular Imaging

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Background-Up to 30% of patients with severe aortic stenosis (SAS; indexed aortic valve area <0.6 cm 2 /m 2 ) present with low transvalvular gradient despite a normal left ventricular ejection fraction. Presently, there is intense controversy as to the prognostic implications of such findings. Accordingly, the aim of the present work was to compare the natural history of patients with paradoxical low-gradient (PLG) or high-gradient (HG) SAS. Methods and Results-We prospectively studied 349 patients with SAS and preserved left ventricular ejection fraction.Patients were categorized into HG-SAS (n=144) and PLG-SAS (n=205) according to mean transvalvular gradient (mean gradient >40 or ≤40 mm Hg). Primary end points were all-cause mortality and echocardiographic disease progression. To evaluate natural history, patients undergoing aortic valve replacement were censored at the time of surgery (n=92). During a median follow-up of 28 months, 148 patients died. Kaplan-Meier survival curves showed better survival in PLG-SAS than in HG-SAS, both in the overall population (48% versus 31%; P<0.01) and in the asymptomatic subgroup (59% versus 35%; P<0.02). In asymptomatic patients, Cox analysis identified age, diabetes mellitus, left atrial volume, and mean gradient as independent predictors of death. Finally, at last echocardiographic follow-up, PLG-SAS demonstrated significant increases in mean gradient (from 29±6 to 38±11 mm Hg; P<0.001). Conclusions-Our study indicates that PLG-SAS is a less malignant form of AS compared with HG-SAS, because their spontaneous outcome is better. We further demonstrated that patients with PLG-SAS are en route toward the more severe HG-SAS form, because the majority of them evolve into HG-SAS over time. (Circ Cardiovasc Imaging. 2014;7:714-722.)

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“…The authors found that 2D methods underestimated LVOT area by 21% (P<0.05) compared with 3D planimeter of LVOT area (4.1±0.1 cm 2 ). Out of 66 patients, 8 patients (12%) who had originally been classified as severe AS by the 2D method were reclassified as moderate AS by the 3D method (P<0.001) (20). Therefore, 3D-derived measurements of AVA are not only more accurate, but have more the potential to impact surgical decision-making in AS.…”

Section: D a Bmentioning

confidence: 97%

An update on intraoperative three-dimensional transesophageal echocardiography

Rong¹

2017

J. Thorac. Dis.

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Impact of Three-Dimensional Echocardiography on Classification of the Severity of Aortic Stenosis

Cited by 37 publications

References 23 publications

Aortic valve area using computed tomography‐derived correction factor to improve the validity of left ventricular outflow tract measurements

Aortic valve area using computed tomography‐derived correction factor to improve the validity of left ventricular outflow tract measurements

Natural History of Paradoxical Low-Gradient Severe Aortic Stenosis

An update on intraoperative three-dimensional transesophageal echocardiography

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