3-Dimensional Echocardiographic Prediction of Left Ventricular Outflow Tract Area Prior to Transcatheter Mitral Valve Replacement

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2024-10-01 DOI:10.1016/j.jcmg.2024.05.011

Joanna Bartkowiak MD , Chrisoula Dernektsi MD , Vratika Agarwal MD , Mark A. Lebehn MD , Treena A. Williams MS , Russel A. Brandwein MS , Nicolas Brugger MD , Christoph Gräni MD , Stephan Windecker MD , Torsten P. Vahl MD , Tamim M. Nazif MD , Isaac George MD , Susheel K. Kodali MD , Fabien Praz MD , Rebecca T. Hahn MD

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引用次数: 0

Abstract

Background

New postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo–left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR).

Objectives

This study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT).

Methods

A total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients.

Results

There was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm², limit of agreement: −92.2 mm² to 143.3 mm²; P < 0.001; mean bias pre/post CT: 28.3 mm², limit of agreement: −65.8 mm² to 122.4 mm²; P = 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r² = 0.481; P < 0.001 for TEE and r² = 0.401; P < 0.001 for CT).

Conclusions

TEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.

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经导管二尖瓣置换术前左心室流出道面积的三维超声心动图预测

背景：新的后处理软件有助于在接受经导管二尖瓣置换术（TMVR）的患者中通过三维（3D）超声心动图确定二尖瓣环（MA）和新左室流出道（neo-LVOT）的尺寸：本研究旨在检验三维超声心动图分析与基线计算机断层扫描（CT）相比的准确性：回顾性纳入了2017年10月至2023年5月期间在2家三级医疗中心接受TMVR的105例连续患者。使用专用软件在基线 CT 和三维经食道超声心动图（TEE）中投射虚拟瓣膜。在基线图像中测量 MA 的尺寸，在基线和手术后图像中测量新 LVOT 的尺寸。所有测量结果均与作为参考的基线 CT 进行比较。预测的新 LVOT 面积与手术后 LVOT 梯度峰值相关：结果：两种成像模式对基线新 LVOT 的预测无明显偏差。与 CT 相比，TEE 明显低估了 MA 面积、周长和内外侧尺寸。两种成像模式都明显低估了实际的 neo-LVOT 面积（TEE 前后的平均偏差：25.6 平方毫米，差异极限：-92.2 平方毫米至 143.3 平方毫米；P < 0.001；CT 前后的平均偏差：28.3 平方毫米，差异极限：-65.8 平方毫米至 122.4 平方毫米；P = 0.046），使用专用二尖瓣生物瓣膜治疗组的 neo-LVOT 被低估。CT 和 TEE 预测的新 LVOT 面积均与术后 LVOT 梯度呈反相关性（TEE 为 r2 = 0.481；P < 0.001；CT 为 r2 = 0.401；P < 0.001）：结论：在预测 TMVR 后的新 LVOT 面积和峰值梯度方面，TEE 导出的分析结果与 CT 导出的指标相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.