Evaluation Of Aortic Root Structure By Transesophageal Three-dimensional Echocardiography: A Controlled Study With CT

Objective:To explore the reproducibility of an automated reprocessing software for the quantitative measurements of normal aortic roots by three-dimensional transesophageal echocardiography(3D-TEE).Methods:Patients with normal aortic roots were prospective enrolled,whose diameters of the aortic annulus(AA),sinus of Valsalva(SOV),and sino-tubular junction(STJ)were measured in either full-automated or semi-automated manner by the eSie Valves(Siemens)software offline after 3D-TEE examinations.Full-automated measurements were operated by a product engineer,and semi-automated measurements were completed separately by two experienced echocardiographer,one of whom repeated the measurements in different times.The intra-and inter-observer differences between the average values of the measurements were compared with the paired t test.The correlations(r)were calculated by the Pearson linear correlation analysis,and the consistencies were evaluated by intra-class correlation coefficients(ICCs)and Bland-Altman analyses.Results:A total of 67 patients were included in the study.The intra-and inter-observer absolute mean differences among semi-automated measurements were 0.002cm-0.045cm and 0.043cm-0.210cm;the absolute mean differences among full-automated measurements were 0.009cm-0.604cm.The intra-and inter-observer correlation coefficients(r)among semi-automated measurements were 0.7940-0.9624 and 0.7792-0.9250;the correlation coefficients(r)among full-automated measurements were 0.8889-0.9709.All r values were statistically significant(p<0.0001).The intra-and inter-observer ICCs among semi-automated measurements were 0.7936-0.9595 and 0.7459-0.9248;the ICCs among full-automated measurements were 0.8889-0.9709.Bland-Altman analyses demonstrated the high consistencies of all groups,no matter the semi-automated or the full-automated measurements.Conclusion:The reproducibility of the automated reprocessing software,eSie Valves,for the quantitative measurements of normal aortic roots by 3D-TEE is satisfactory,thus deserves a good clinical perspective.Objectives:To prove the accuracy of an automated reprocessing software for the quantitative measurements of normal aortic roots by three-dimensional transesophageal echocardiography(3D-TEE),intra-individually compared with multidetector computed tomography(MDCT).Methods:Patients with normal aortic roots were prospective enrolled,who simultaneously received the two-dimensional transthoracic echocardiography(2D-TTE),two-dimensional transesophageal echocardiography(2D-TEE),3D-TEE and MDCT.The 3D-TEE images were offline analyzed by the eSie Valves software(Siemens)in either full-automated or semi-automated manner.The aortic annulus(AA),sinus of Valsalva(SOV),and sino-tubular junction(STJ)were measured by the average diameters(-Aver),perimeter-derived diameters(-Peri)and area-derived diameters(-Area).The differences among multimodalities and metering methods were compared with the paired t test.The correlations(r)were calculated by the Pearson linear correlation analysis,and the limits of agreements(LOA)were evaluated by Bland-Altman analyses.To set MDCT-Area as the standard,the accuracies of the diameters measured by multimodalities and metering methods were investigated.The accuracies of the full automated measurements were further accessed regarding Semi-Area as reference.Results:A total of 67 patients were included in the study.The AA,SOV,STJ diameters measured by MDCT-Area were 2.36±0.22cm,3.27±0.36cm,2.82±0.32cm.To set MDCT-Area as standard,the maximum mean differences of AA,SOV and STJ were 2.0030mm(2D-TEE),1.9700mm(MDCT-Peri)and 2.4100mm(Full-Peri)respectively.The general trend of the AA measurements among multimodalities was that the diameters measured by the 2D-TTE and 2D-TEE was smaller(p<0.05),the measurements by the full-automated 3D-TEE was larger(p<0.05),the values measured by the semi-automated 3D-TEE approximated to MDCT(p>0.05).The overall trend of STJ measurements was similar to that of AA,but the overall trend of SOV was somehow not obvious.Among different metering methods,the perimeter-derived diameters(-Peri)was the largest,the average diameters(-Aver)and the area-derived diameters(-Area)were smaller,which was more remarkable for SOV diameters.Among multimodalities,the LOA was the smallest for MDCT,the largest for the full-automated 3D-TEE.The LOAs for the 2D-TTE,2D-TEE,and the semi-automated 3D-TEE were moderate and similar.Among different metering methods,the LOA was the largest for SOV.The LOAs for AA and STJ were relatively smaller.To set the MDCT-Area as standard,the correlation coefficients(r)of AA,SOV and STJ among multimodalities were 0.5860-0.9399,0.8404-0.9551 and 0.7770-0.9826 respectively.The measurements between the semi-automated 3D-TEE and MDCT were well correlated,and the correlation coefficients(r)of AA,SOV and STJ were 0.6647-0.7926,0.8105-0.8895 and 0.8444-0.8636 respectively.The fault rate of the full-automated 3D-TEE(??3mm)was 16.4%,regarding Semi-Area as reference.Conclusion:The eSie Valves,as a novel 3D-TEE reprocessing software,can accurately measure the anatomical diameters of the aortic roots,and the measurements obtained by eSie Valves semi-automated manner are identical with MDCT.The full-automated method needs to optimize further in the future.Objective:To explore the usefulness of the automated measurements of three-dimensional transesophageal echocardiography(3D-TEE)for hypothetical transcatheter heart valve(THV)sizing.Methods:Hypothetical THV sizing was performed based on the two-dimensional transthoracic echocardiography(2D-TTE),two-dimensional transesophageal echocardiography(2D-TEE),eSie Valves semi-automated 3D-TEE and multidetector computed tomography(MDCT)measurements of the aortic annuluses,taking SAPIEN 3,CoreValve and Lotus valves for example.The criteria in user manuals were followed.The comparison among the THV sizing results were analyzed by chi-square test and Fisher precise test.Results:The differences of the aortic annulus diameters among different modalities(2D-TTE,2D-TEE,3D-TEE and MDCT)did affect the THV sizing.For SAPIEN 3 valves,the THV sizing results based on the 2D-TTE and 2D-TEE measurements were similar to the results based on MDCT(p>0.05).The THV sizing results based on the eSie Valves semi-automated 3D-TEE measurements were similar to the results based on MDCT(p>0.05),if the "TEE" criterion in the user manual was followed,however,more large valves were chosen if the "MDCT" criterion in the user manual was followed(p<0.05).For CoreValve and Lotus valves,the THV sizing results based on the eSie Valves semi-automated 3D-TEE measurements were similar to the results based on MDCT(p>0.05),but more smaller valves were chosen if based on the 2D-TTE and 2D-TEE measurements(p<0.05).Conclusion:THV sizing based on the eSie Valves semi-automated 3D-TEE measurements can achieve similar results to MDCT.For balloon-expanded valves(such as SAPIEN 3),the "MDCT" criterion in the user manual is preferred rather than the traditional "TEE" criterion,when should THV sizing based on this automated 3D-TEE measurements.