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Comparison between Three-Dimensional Echocardiography and Computed Tomography for Comprehensive Tricuspid Annulus and Valve Assessment in Severe Tricuspid Regurgitation: Implications for Tricuspid Regurgitation Grading and Transcatheter Therapies
Journal of the American Society of Echocardiography ( IF 6.5 ) Pub Date : 2018-09-27 , DOI: 10.1016/j.echo.2018.07.007
Fabien Praz , Omar K. Khalique , Leon G. Dos Reis Macedo , Todd C. Pulerwitz , Jennifer Jantz , Isaac Y. Wu , Alex Kantor , Amisha Patel , Torsten Vahl , Vinayak Bapat , Isaac George , Tamim Nazif , Susheel K. Kodali , Martin B. Leon , Rebecca T. Hahn

Background

Tricuspid valve imaging is frequently challenging and requires the use of multiple modalities. Knowledge of limitations and methodologic discrepancies among different imaging techniques is crucial for planning transcatheter valve interventions.

Methods

Thirty-eight patients with severe symptomatic tricuspid regurgitation were included in this retrospective analysis. Tricuspid annulus (TA) measurements were made during mid-diastole using three-dimensional (3D) transthoracic echocardiographic direct planimetry (TTE_direct) and transesophageal echocardiographic direct planimetry (TEE_direct). Moreover, a semiautomated software was used to generate two-dimensional (2D) and 3D perimeter and area on transesophageal echocardiography (TEE) images. Both methods were compared with direct computed tomographic planimetry (CT_direct) and cubic spline interpolation (CT_indirect). The different TA values were used to calculate the effective regurgitant orifice area and compared with 3D Doppler vena contracta area. For tricuspid valve area TEE_direct and CT_direct as well as CT_indirect were measured.

Results

Agreement between TEE and computed tomography (CT) for TA sizing was obtained using semiautomated methods (3D TEE_indirect and CT_indirect). TTE_direct was overall less reliable compared with CT. TA area quantified by TEE_direct was 25% (difference 305 ± 238 mm2, P < .001, R = 0.9) and 19% (166 ± 247 mm2, P < .001, R = 0.89) smaller compared with CT_direct and CT_indirect, respectively. TA perimeter measurements by TEE_direct differed by 11% compared with CT_direct (12 ± 11 mm, P < .001, R = 0.87) and 3D CT_indirect (12 ± 11 mm, P < .001, R = 0.88), and 9% compared with 2D CT_indirect (7 ± 11 mm, P = .002, R = 0.87). TEE_direct of the TA allows the most accurate calculation of effective regurgitant orifice area compared with 3D vena contracta area (−8 ± 62 mm2, P = .50, R = 0.85). Tricuspid valve area by CT_indirect best correlated with conventional TEE_direct (80 ± 250 mm2, P = .11, R = 0.80).

Conclusions

In patients with severe tricuspid regurgitation, semiautomated indirect planimetry results in high agreement between TEE and CT for TA sizing and measurement of the tricuspid valve area. TEE_direct of the TA allows the most accurate measurement of diastolic stroke volume for the calculation of regurgitation severity compared with 3D vena contracta area.



中文翻译:

三维超声心动图和计算机断层扫描技术在三尖瓣反流严重的情况下对三尖瓣环的瓣膜瓣和瓣膜评估的比较:对三尖瓣反流分级和经导管治疗的意义

背景

三尖瓣成像通常具有挑战性,需要使用多种方式。了解不同成像技术之间的局限性和方法差异对计划经导管瓣膜干预至关重要。

方法

这项回顾性分析包括38例严重症状性三尖瓣关闭不全患者。使用三维(3D)经胸超声心动图直接平面测量(TTE_direct)和经食管超声心动图直接平面测量(TEE_direct)在心脏舒张中期进行三尖瓣环(TA)测量。此外,使用半自动化软件在经食道超声心动图(TEE)图像上生成二维(2D)和3D周边和区域。将这两种方法与直接计算机断层扫描平面法(CT_direct)和三次样条插值(CT_indirect)进行了比较。使用不同的TA值计算有效的返流孔面积,并与3D多普勒静脉收缩面积进行比较。对于三尖瓣面积,测量了TEE_direct和CT_direct以及CT_indirect。

结果

使用半自动方法(3D TEE_indirect和CT_indirect)获得TEE和计算机断层扫描(CT)之间用于TA大小调整的协议。与CT相比,TTE_direct总体上不太可靠。通过TEE_direct量化的TA面积比CT_direct和CT_indirect小25%(差305±238 mm 2P  <.001,R  = 0.9)和19%(166±247 mm 2P  <.001,R  = 0.89)小, 分别。与CT_direct(12±11 mm,P  <.001,R  = 0.87)和3D CT_indirect(12±11 mm,P  <.001,R)相比,TEE_direct的TA周边测量值相差11% = 0.88),与2D CT_indirect(7±11 mm,P  = .002,R  = 0.87)相比,为9%。TA的TEE_direct与3D腔静脉收缩面积(-8±62 mm 2P  = .50,R  = 0.85)相比,可以最准确地计算出有效的反流口面积。CT_indirect的三尖瓣面积与传统的TEE_direct最佳相关(80±250 mm 2P = .11,R = 0.80)。

结论

对于患有严重三尖瓣关闭不全的患者,半自动间接平面测量法会导致TEE和CT在TA大小和三尖瓣瓣膜面积的测量方面高度吻合。与3D腔静脉收缩面积相比,TA的TEE_direct可以最准确地测量舒张性卒中量,以计算反流的严重程度。

更新日期:2018-09-27
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