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Aortic roots assessment by an automated three-dimensional transesophageal echocardiography: an intra-individual comparison

  • Minghui Zhang
  • Linyuan Wan
  • Kun Liu
  • Weichun Wu
  • Hui Li
  • Yuan Wang
  • Bin Lu
  • Hao WangEmail author
Original Paper
  • 12 Downloads

Abstract

To evaluate the accuracy, reproducibility, and transcatheter heart valve (THV) sizing efficiency of an automated 3-dimensional transesophageal echocardiographic (3D-TEE) post-processing software in the assessments of aortic roots, intra-individually compared with multidetector computed tomography (MDCT). We prospectively studied 67 patients with normal aortic roots. We measured diameters of aortic annulus (AA), sinus of Valsalva (SOV), and sino-tubular junction (STJ) by full-automated and semi-automated methods using 3D-TEE datasets, then compared them to corresponding transthoracic echocardiography and MDCT values. THV sizes were chosen based on echocardiography and MDCT measurements according to recommended criterion. Taking MDCT planimetered diameters as reference, the full-automated (r: 0.4745–0.8792) and semi-automated (r: 0.6647–0.8805) 3D-TEE measurements were linearly correlated (p < 0.0001). The average differences between semi-automated or full-automated measurements and reference were 0.3 mm or 1.3 mm for AA, − 1.9 mm or − 0.5 mm for SOV, and − 0.1 mm or 1.9 mm for STJ, respectively. The intra-class correlation coefficients of semi-automated method were 0.79–0.96 (intra-observer) and 0.75–0.92 (inter-observer). THV sizing by semi-automated measurements using echocardiographic criteria was larger than that by MDCT measurements using MDCT criteria (p < 0.0001) but equivalent (p > 0.05) if both using MDCT standards. The new automated 3D-TEE software allows modeling and quantifying aortic roots with high reproducibility. Measurements by the semi-automated method closely approximate and well correlate with the corresponding MDCT, thus THV sizing by this modeled 3D-TEE measurements should adopt recommended MDCT criteria but not echocardiographic criteria. The full-automated 3D-TEE segmentations are yet immature. (Semi-automated assessMent of Aortic Roots by Three-dimensional transEsophageal echocaRdiography [SMARTER], NCT02724709)

Keywords

Three-dimensional transesophageal echocardiography Multidetector computed tomography Transcatheter aortic valve replacement Automated measurement 

Notes

Acknowledgements

The authors thank Dr. Chuangshi Wang (Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases; 15 Fengcunxili, Beijing 102308, China) and Dr. Zhilan Zheng (Division of Ultrasound Application, Siemens Healthineers China; 7 Wangjing Zhonghuan South Road, Beijing 100102, China) for their helps.

Funding

This work was supported by the Peking Union Medical College Youth Fund from the Fundamental Research Funds for the Central Universities (No. 3332015013, to MZ) and partly by the National Natural Science Foundation of China (No. 81470080, to WH).

Compliance with ethical standards

Conflict of interests

The authors have no conflicts to declare.

Supplementary material

Supplementary file1 (AVI 14875 kb) Dynamic videos of 3D-TEE recording (example)

Supplementary file2 (AVI 11145 kb) Dynamic videos of 3D-TEE recording (example)

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Supplementary file3 (AVI 7486 kb) Dynamic videos of automated 3D-TEE modeling (example)
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Supplementary file4 (AVI 2969 kb) Dynamic videos of automated 3D-TEE modeling (example)
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Supplementary file5 (AVI 7038 kb) Dynamic videos of automated 3D-TEE modeling (example)
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Supplementary file6 (AVI 6284 kb) Dynamic videos of automated 3D-TEE modeling (example)
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Supplementary file7 (TIFF 1424 kb)
10554_2019_1664_MOESM8_ESM.docx (190 kb)
Supplementary file8 (DOCX 189 kb) Supplementary Figure 2: Bland-Altman analysis of AA, SOV, and STJ diameters, regarding MDCT-Area as reference standard
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Supplementary file9 (DOCX 195 kb) Supplementary Figure 3: Correlation among various measurements of AA diameters
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Supplementary file10 (DOCX 183 kb) Supplementary Figure 4: Correlation among various measurements of SOV diameters
10554_2019_1664_MOESM11_ESM.docx (192 kb)
Supplementary file11 (DOCX 192 kb) Supplementary Figure 5: Correlation among various measurements of STJ diameters
10554_2019_1664_MOESM12_ESM.docx (141 kb)
Supplementary file12 (DOCX 141 kb) Supplementary Figure 6: Variability of the semi-automated and full-automated modeling measurements
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Supplementary file13 (TIFF 1642 kb)
10554_2019_1664_MOESM14_ESM.docx (18 kb)
Supplementary file14 (DOCX 18 kb) Supplementary Table 1: Manufacturer recommended sizing criterion (SAPIEN 3 & CoreValve)
10554_2019_1664_MOESM15_ESM.docx (23 kb)
Supplementary file15 (DOCX 22 kb) Supplementary Table 2: MDCT characteristics of the study population
10554_2019_1664_MOESM16_ESM.docx (46 kb)
Supplementary file16 (DOCX 45 kb) Supplementary Table 3: AA, SOV and STJ diameters measured by various methods
10554_2019_1664_MOESM17_ESM.docx (82 kb)
Supplementary file17 (DOCX 81 kb) Supplementary Table 4: The average differences among various measurements of AA, SOV, and STJ diameters

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Minghui Zhang
    • 1
  • Linyuan Wan
    • 1
  • Kun Liu
    • 2
  • Weichun Wu
    • 1
  • Hui Li
    • 1
  • Yuan Wang
    • 3
  • Bin Lu
    • 2
  • Hao Wang
    • 1
    Email author
  1. 1.Department of Echocardiography, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingChina
  2. 2.Department of Radiologic Imaging, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingChina
  3. 3.Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular DiseasesBeijingChina

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