Accuracy of 2-dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: Echocardiographic-anatomic correlation in 115 patients

Brandenburg, Robert O.; Tajik, A. Jamil; Edwards, William D.; Reeder, Guy S.; Shub, Clarence; Seward, James B.

doi:10.1016/0002-9149(83)90659-8

Cited by 152 publications

(63 citation statements)

References 11 publications

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“…Echocardiography is routinely performed in all patients with suspected coarctation and is considered the diagnostic tool of choice for imaging the valvular anatomy of the heart. Two-dimensional echocardiography has a reported a sensitivity and specificity for bicuspid aortic valve diagnosis of 92% and 96%, respectively (15). Three-dimensional echocardiography has also been shown to be a reliable technique for defining the morphological details of bicuspid aortic valves, with precision comparable to anatomicopathologic examination (16), and transesophageal echocardiography has also been reported to have a higher degree of sensitivity and specificity than the transthoracic route (17).…”

Section: Discussionmentioning

confidence: 99%

Steady‐state free‐precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves

Gleeson

Mwangi

Horgan

et al. 2008

Magnetic Resonance Imaging

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Purpose: To assess the diagnostic sensitivity and specificity of double-oblique true fast imaging with steady-state precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves. Materials and Methods:Echocardiograms on patients referred for MRI of the heart and thoracic aorta over a fouryear period were reviewed retrospectively. A total of 17 patients with bicuspid aortic valve were identified and compared to 21 randomly chosen control patients. All patients had double-oblique SSFP (True FISP) cine MRI of the aortic valve independently assessed by two radiologists in a blinded fashion, and graded as bicuspid or normal. Image quality was graded as 1, 2, or 3. Discordance was resolved by consensus.Results: A total of 38 cases were reviewed (27 men, 11 women; age range ϭ 15-67 years, mean ϭ 25.33 years). Interobserver agreement was 0.97 (36/38 cases). One case of normal tricuspid valve was reported as bicuspid by both readers (false-positive). All cases in which disparity arose were rated suboptimal by both readers (grade 2 or 3). Consensus review yielded sensitivity ϭ 100%, specificity ϭ 95.2%, positive predictive value ϭ 94.4%, and negative predictive value ϭ 100%; overall diagnostic accuracy was 97.36%. Interobserver agreement was 0.97. BICUSPID AORTIC VALVE is a common congenital anomaly, with an incidence of 0.9% to 2% in the general population (1). It is associated with aortic stenosis, aortic incompetence, aortic dissection, aneurysm formation (2), infective endocarditis, and aortic coarctation (3). Up to 85% of cases of aortic coarctation have concomitant bicuspid aortic valve morphology (4) and in this group there is a significant association with ascending aortic aneurysm (5). Inheritance may be multifactorial, or autosomal dominant, and is more common in men (6). The diagnosis of bicuspid aortic valve is routinely made using cross sectional two-dimensional (2D) and Doppler echocardiography. Diagnosis is based on the demonstration of two cusps and two commissures during short-axis (SA) visualization. Features such as a single coaptation line between cusps during diastole, cusp redundancy, and eccentric valve closure support the diagnosis. ConclusionMRI is established as one of the most accurate noninvasive modalities in the study of aortic diseases (7,8). Breathhold cine sequences using steady-state free-precession (SSFP) acquisitions, e.g., true fast imaging with steady-state precession (TrueFISP) (Siemens Medical Systems, Erlangen, Germany) combine the advantage of short acquisition times and high signal-to-noise ratio, thus optimizing blood-myocardium contrast (9). Cine sequences are commonly employed to evaluate aortic valve morphology, but the diagnostic accuracy of these sequences in determining aortic valve morphology is unknown.The aim of this study was to determine the sensitivity and specificity of double-oblique TrueFISP cine MRI in distinguishing normal and bicuspid aortic valves when compared with echocardiography as a gold standard. MATERIALS AND METHODSHospital ethics comm...

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Section: Discussionmentioning

confidence: 99%

Steady‐state free‐precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves

Gleeson

Mwangi

Horgan

et al. 2008

Magnetic Resonance Imaging

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“…Brandenburg et al stated that whatever the number of cusps, one can obtain different numbers of sinuses and different shapes of raphes. 15 In our study, we found that cross-sectional echocardiography, in its short axis view of the aortic valve, is a prerequisite in determining the number of aortic cusps. The prevalence rate of bicuspid aortic valve varies from one study to another, while Brandenburg reported a rate ranging between 0.4% and 2.0% of all births, which is considered the highest rate reported.…”

Section: Discussionmentioning

confidence: 72%

Prevalence of Bicuspid Aortic Valve and Mitral Valve Prolapse in a Healthy Saudi Population and the Clinical Implications of their Association

et al. 1996

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“…Cardiovasc Diagn Ther 2017;7(4):367-379 cdt.amegroups.com or intervention, and with expert readers who jointly evaluated images for presence of BAV (18)(19)(20)(21)(22). Conversely, we aimed at assessing the diagnostic accuracy of primary investigators during routine echocardiography.…”

Section: Low Sensitivity Of Routine Echocardiographymentioning

confidence: 99%

“…The most likely reason is that calcified masses can overly and erode the aortic valve anatomy and thereby conceal the underlying cusp structure. Finally, Brandenburg et al pointed out in their classical study of TTE for BAV that in diastole a raphe in BAV may appear like a commissure of TAV (19). Therefore, BAV without a raphe may be easier to diagnose than BAV with a raphe (4).…”

Section: Predictors Of Inaccurate Diagnosismentioning

confidence: 99%

Diagnostic accuracy study of routine echocardiography for bicuspid aortic valve: a retrospective study and meta-analysis

Hillebrand¹,

Koschyk²,

Hark³

et al. 2017

Cardiovasc. Diagn. Ther.

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Background: Transthoracic echocardiography (TTE) is the standard procedure to distinguish tricuspid aortic valve (TAV) from bicuspid aortic valve (BAV). Published studies assessed the accuracy of TTE for BAV under ideal conditions. Conversely, we aimed at assessing accuracy of TTE for BAV under routine conditions.Methods: This retrospective, cross-sectional study of 216 adults included 132 men aged 62±14 years.Of these, 108 had BAV and 108 were age-matched individuals with TAV. All diagnoses were confirmed at surgery. We assessed TTE in two patient groups. First, in the (I) group of all 216 individuals, where we assessed accuracy for BAV according to the original diagnoses as documented by the primary investigators during original TTE examination. Second, we assessed accuracy for BAV according to expert re-evaluation in (II) all 158 TTE with availability of original recordings. Third, we performed a meta-analysis of published results on the accuracy of TTE for BAV according to PRISMA standards.Results: Sensitivity, specificity and accuracy of (I) primary investigators was 46.3%, 97.2, and 71.8% as compared to (II) expert re-evaluation with 59.7%, 93%, and 77.8%, respectively. Sensitivity was significantly higher at re-evaluation (P<0.001). TTE at a non-tertiary care center (P=0.012), presence of aortic aneurysm (P=0.001) and presence of severe aortic valve calcification (P=0.003) predicted an inaccurate diagnosis of BAV. Conversely, meta-analysis of published TTE studies identified a pooled sensitivity of 87.7% and a pooled specificity of 88.3% for BAV.Conclusions: The current study shows that TTE yields almost ideal diagnostic accuracy when ideal investigators examine ideal patients. However, the study also shows that TTE yields suboptimal diagnostic accuracy under routine conditions. TTE in non-tertiary care settings, concomitant aortic aneurysm, and presence of severe aortic valve calcification predict an inaccurate diagnosis of BAV.

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Accuracy of 2-dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: Echocardiographic-anatomic correlation in 115 patients

Cited by 152 publications

References 11 publications

Steady‐state free‐precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves

Steady‐state free‐precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves

Prevalence of Bicuspid Aortic Valve and Mitral Valve Prolapse in a Healthy Saudi Population and the Clinical Implications of their Association

Diagnostic accuracy study of routine echocardiography for bicuspid aortic valve: a retrospective study and meta-analysis

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