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Assessment of Aortic Stenosis by Three-Dimensional Echocardiography: An Accurate and Novel Approach
  1. Sorel Goland (golands{at}cshs.org)
  1. Cedars-Sinai Medical Center,Division of Cardiology, United States
    1. Alfredo Trento (trentoa{at}cshs.org)
    1. Cedars-Sinai Medical Center, Division of Cardiothoracic surgery, United States
      1. Kiyoshi Iida (iidak{at}cshs.org)
      1. Cedars-Sinai Medical Center,Division of Cardiology, United States
        1. Lawrence SC Czer (czer{at}cshs.org)
        1. Cedars-Sinai Medical Center, Division of Cardiology, United States
          1. Michele De Robertis (dereobertism{at}cshs.org)
          1. Cedars-Sinai Medical Center, Division of Cardiothoracic surgery, United States
            1. Tasneem Z Naqvi (naqvit{at}cshs.org)
            1. Cedars-Sinai Medical Center, Division of Cardiology, United States
              1. Kirsten Tolstrup (tolstrupk{at}cshs.org)
              1. Cedars-Sinai Medical Center, Division of Cardiology, United States
                1. Takasi Akima (akimat{at}cshs.org)
                1. Cedars-Sinai Medical Center, Division of Cardiology, United States
                  1. Huai Luo (luoh{at}cshs.org)
                  1. Cedars-Sinai Medical Center, Division of Cardiology, United States
                    1. Robert J Siegel (siegel{at}cshs.org)
                    1. Cedars-Sinai Medical Center, Division of Cardiology, United States

                      Abstract

                      Background: Accurate assessment of aortic valve area (AVA) is important for clinical decision making in patients with aortic valve stenosis (AS). The role of three-dimensional echocardiography (3D) in the quantative assessment of AS has not been evaluated.

                      Objectives: To evaluate the reproducibility and accuracy of real-time three-dimensional echocardiography (RT3D) and 3D-guided two-dimensional planimetry (3D/2D) for assessment of AS and compare these results with standard echocardiography and cardiac catheterization (Cath).

                      Methods: AVA was estimated by transthoracic echo-Doppler (TTE) and by direct planimetry using transesophageal echocardiography (TEE) as well as RT3D and 3D/2D. 15 patients underwent assessment of AS by Cath.

                      Results: 33 patients with AS were studied (20 men, age 70± 14). Bland-Altman analysis showed good agreement and small absolute differences in AVA between all planimetric 3 methods (RT3D vs. 3D/2D: -0.01 cm² ± 0.15; 3D/2D vs. TEE: 0.05 cm² ± 0.22; RT3D vs. TEE: 0.06 cm² ±0.26). The agreement between AVA by 2D-TTE and planimetry was: -0.01 ± 0.20 cm² for 3D/2D for 3D/2D; 0.00 ± 0.15 cm² for RT3D; and -0.05 ± 0.30 cm² for TEE .Correlation for AVA between 3D/2D, RT3D, TEE planimetry and Cath was r=0.81, r=0.86, and r=0.71, respectively. The intra-observer variability was similar for all methods, but inter-observer variability was better for 3D techniques compared to TEE (p< 0.05).

                      Conclusions: The 3D echo methods for planimetry of the AVA showed good agreement with standard TEE technique and flow derived methods. Compared with AV planimetry by TEE, both 3D methods were at least as good as TEE and had better reproducibility. 3D aortic valve planimetry is a novel non-invasive technique, which provides accurate, reliable quantitative assessment of AS.

                      • aortic stenosis
                      • aortic valve
                      • echocardiography
                      • planimetry
                      • three-dimensional

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