Echocardiographic Screening for Transcatheter Edge-to-Edge Mitral Valve Repair: Correlation Between Transthoracic and Transesophageal Assessment.

IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Michela Bonanni, Fausto Pizzino, Giovanni Benedetti, Rosangela Capasso, Rachele Manzo, Giuseppe Iuliano, Giancarlo Trimarchi, Andreina D'Agostino, Umberto Paradossi, Alessia Gimelli, Sergio Berti, Massimiliano Mariani
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引用次数: 0

Abstract

Background: In patients with significant mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (M-TEER), assessment of mitral valve (MV) anatomy is essential. While transthoracic echocardiography (TTE) is the initial diagnostic tool, transesophageal echocardiography (TOE) provides better anatomical details. The study aims to assess whether TTE is as effective as TOE in selecting patients with severe MR who are eligible for M-TEER.

Methods: From January to December 2024, patients with severe MR eligible for TEER were enrolled at the Fondazione Monasterio Heart Hospital, Italy. They underwent a comprehensive TTE and TOE examination. Cardiologists assessed the severity of MR and valve anatomy using specific protocols. Measurements included MV area, MV gradient, posterior leaflet length, fossa ovalis high, presence of fails, clefts, and calcifications. Three levels of anatomic complexity were defined to determine eligibility for TEER.

Results: The study includes 40 patients with severe MR. The correlation between TTE and TOE for key parameters was strong, with coefficients ranging from 0.734 to 0.901, indicating high agreement between the two methods. The comparison of categorical features showed high agreement between TTE and TOE in detecting critical MV conditions, with kappa values ranging from 0.717 to 0.930. The agreement for classifying patients as suitable for M-TEER was 87.5%, indicating moderate consistency between the two methods.

Conclusions: TTE may be a viable alternative to TOE for assessing MV anatomy and function before M-TEER in MR patients, especially in high-volume centers. While TTE strongly correlated with TOE for most parameters, TOE was superior for some features. Further research is needed to refine the clinical application of TTE and to define patient selection criteria for its use as the primary imaging modality for pre-procedural M-TEER screening.

超声心动图筛查经导管二尖瓣边缘到边缘修复:经胸和经食管评估的相关性。
背景:在接受经导管边缘到边缘修复(M-TEER)的严重二尖瓣返流(MR)患者中,评估二尖瓣(MV)解剖是必不可少的。虽然经胸超声心动图(TTE)是最初的诊断工具,但经食管超声心动图(TOE)提供了更好的解剖细节。该研究旨在评估在选择有资格接受M-TEER治疗的严重MR患者时,TTE是否与TOE一样有效。方法:2024年1月至12月,意大利Monasterio基金会心脏医院(Fondazione Monasterio Heart Hospital)符合TEER条件的严重MR患者。他们接受了全面的TTE和TOE检查。心脏病专家使用特定的方案评估MR和瓣膜解剖的严重程度。测量包括中压面积、中压梯度、后小叶长度、卵圆窝高度、有无衰竭、裂隙和钙化。定义了三个层次的解剖复杂性来确定TEER的资格。结果:本研究纳入40例重度mr患者,TTE与TOE关键参数相关性较强,相关系数在0.734 ~ 0.901之间,两种方法吻合度较高。分类特征比较表明,TTE和TOE在检测临界MV条件上的一致性较高,kappa值在0.717 ~ 0.930之间。对适合M-TEER的患者进行分类的一致性为87.5%,表明两种方法的一致性中等。结论:对于MR患者,特别是在高容量中心,在M-TEER前评估中压解剖和功能,TTE可能是TOE的可行替代方案。虽然TTE与TOE在大多数参数上密切相关,但TOE在某些特征上优于TOE。需要进一步的研究来完善TTE的临床应用,并确定患者选择标准,将其作为术前M-TEER筛查的主要成像方式。
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来源期刊
Journal of Cardiovascular Development and Disease
Journal of Cardiovascular Development and Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.60
自引率
12.50%
发文量
381
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