3D color-Doppler echocardiography and chronic aortic regurgitation: A novel approach for severity assessment

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Abstract

Background

3D echocardiography provides a complete evaluation of the aortic valve and adjacent structures and it improves the assessment of this cardiac region. Three-dimensional color-Doppler echocardiography (3DCDE) evaluation might improve the measurements of the functional regurgitant orifice in patients with Chronic Aortic Regurgitation (CAR).

Objectives

Our aim was to compare the accuracy of current echo-Doppler methods and 3DCDE for the assessment of CAR severity. The reference method used in this work was the CAR severity determined by means of cardiac magnetic resonance (CMR)

Methods

Thirty-two consecutive patients with an established diagnosis of CAR recruited in our institution comprised our study group. CAR severity was determined by conventional Echo-Doppler methods and by 3DCDE and their results were compared with those obtained by means of CMR.

Results

Mean age was 63.0 ± 13.5 years. Twenty-two patients (68.8%) were men. Compared with the traditional echo-Doppler methods, 3DCDE evaluation had the best linear association with CMR results (3D vena contracta cross sectional area method: r = 0.88; r square = 0.77; p < 0.001. 3D vena contracta cross sectional area/left ventricular outflow tract cross sectional area method: r = 0.87; r square = 0.75; p < 0.001). The ROC analysis showed an excellent area under curve for detection of severe CAR (3D vena contracta cross sectional area method = 0.97; 3D vena contracta cross sectional area/left ventricular outflow tract cross sectional area method = 0.98). Inter- and intra-observer variability for the 3DCDE evaluation was good (ICC = 0.89 and ICC = 0.91 for inter and intra observer variability respectively).

Conclusions

3DCDE is an accurate and highly reproducible diagnostic tool for estimating CAR severity. Compared with the traditional echo-Doppler methods, 3DCDE has the best agreement with the CMR determined CAR severity. Thus, 3DCDE is a diagnostic method that may improve the therapeutic management of patients with CAR.

Section snippets

Introduction and objectives

The therapeutic management of patients with chronic aortic regurgitation (CAR) represents a challenge for the clinician [1], [2]. This entity is responsible of quality of life impairment and life expectancy reduction in a huge number of patients. To define the best therapeutic strategy, clinical data and accurate measurements of the CAR severity are needed. Nevertheless, currently employed methods are not free from limitations [3].

Three-dimensional echocardiography provides a unique “en-face”

Patient population

Thirty-two consecutive patients with an established diagnosis of CAR [1], recruited in our institution, comprised our study group. Exclusion criteria were more than mild valvular heart disease different of aortic regurgitation (mild valvular lesions were not considered as having a relevant impact on the study results), congenital heart disease, the presence of cardiomyopathies and patient unwillingness to be included in the study. Every patient was given verbal and written information about the

Results

Thirty-two consecutive non-selected patients with CAR were prospectively enrolled. They were the analyzed group. Before ending the inclusion period, five patients were not enrolled due to the unwillingness to undergo a CMR study and one patient was not included due to the presence of an inadequate acoustic window. There were 22 men (68.8%) and mean age was 63.0 ± 13.5 years. CAR was the predominant valvular lesion in all of them but concomitant mild mitral regurgitation was present in 18 patients

Discussion

To our knowledge, this is the first study that evaluates the usefulness of 3DCDE to assess the CAR severity by measuring its functional orifice using as the gold-standard method the CMR evaluation. Furthermore, the results of the present work show that 3DCDE has an excellent correlation with CMR severity evaluation. Looking at these results, 3DCDE assessment is superior to echo-Doppler traditional methods commonly used to evaluate CAR severity.

There are no large-scale studies evaluating the

Study limitations

CMR analysis is not free from limitations [5], [6]. Ideally, the desired gold standard method should have been the direct anatomic measurement performed in the surgical specimen inspection. Another limitation is that the echocardiography delineation of the cardiac structures is always dependent on the quality of the image, in the same manner as every echocardiographic technique. Furthermore, the relatively low temporal resolution of the 3D studies could be considered as other limitation. The

Clinical implications

3DCDE can improve the CAR severity assessment and consequently the management of patients suffering from this valvular heart disease. Thus, 3DCDE is becoming a useful diagnostic method and it could be able to replace other non-invasive methods.

Conclusions

3DCDE is an accurate and highly reproducible diagnostic tool for estimating CAR severity. Compared with the traditional echo-Doppler methods, 3DCDE has the best agreement with the CMR determined CR severity. Thus, 3DCDE is a diagnostic method that may improve the therapeutic management of patients with CAR.

Acknowledgements

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.

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