Aortic roots assessment by an automated three-dimensional transesophageal echocardiography: an intra-individual comparison
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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)
KeywordsThree-dimensional transesophageal echocardiography Multidetector computed tomography Transcatheter aortic valve replacement Automated measurement
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.
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 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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