Assessment of aortic valve tract dynamics using automatic tracking of 3D transesophageal echocardiographic images

Abstract

Purpose: The assessment of aortic valve (AV) morphology is paramount for planning transcatheter AV implantation (TAVI). Nowadays, pre-TAVI sizing is routinely performed at one cardiac phase only, usually at mid-systole. Nonetheless, the AV is a dynamic structure that undergoes changes in size and shape throughout the cardiac cycle, which may be relevant for prosthesis selection. Thus, the aim of this study was to present and evaluate a novel software tool enabling the automatic sizing of the AV dynamically in three-dimensional (3D) transesophageal echocardiography (TEE) images. Methods: Forty-two patients who underwent preoperative 3D-TEE images were retrospectively analyzed using the software. Dynamic measurements were automatically extracted at four levels, including the aortic annulus. These measures were used to assess the software's ability to accurately and reproducibly quantify the conformational changes of the aortic root and were validated against automated sizing measurements independently extracted at distinct time points. Results: The software extracted physiological dynamic measurements in less than 2 min, that were shown to be accurate (error 2.2 ± 26.3 mm 2 and 0.0 ± 2.53 mm for annular area and perimeter, respectively) and highly reproducible (0.85 ± 6.18 and 0.65 ± 7.90 mm 2 of intra-and interobserver variability, respectively, in annular area). Using the maximum or minimum measured values rather than mid-systolic ones for device sizing resulted in a potential change of recommended size in 7% and 60% of the cases, respectively. Conclusion: The presented software tool allows a fast, automatic and reproducible dynamic assessment of the AV morphology from 3D-TEE images, with the extracted measures influencing the device selection depending on the cardiac moment used to perform its sizing. This novel tool may thus ease and potentially increase the observer's confidence during prosthesis' size selection at the preoperative TAVI planning.

The myth of aortic valve annulus changes in aortic valve disease

“…In our study population, 86% of AR patients exhibited maximum annular dimensions during systole. The trend in annular dimension changes from systole to diastole in AR patients mirrored those observed in AS patients in other studies (13)(14)(15)(16). This trend also held in normal individuals (17-19), and those with bicuspid valve malformations (20).…”

Accuracy of aortic annulus measurements by three-dimensional transesophageal echocardiography and predictive value for thoracic aorta aneurysm in patients with aortic regurgitation

“…The AA dimensions were only analyzed when MSCT imaging was in the systolic period. Many studies have confirmed that AA dimensions measured during systole and diastole are different ( 27 , 28 ). However, MSCT scans were performed by prospectively ECG-triggered acquisition mode, and therefore, only images at 25–75% of the R-R interval were available in the present study, which was based on the principle to maximally limit the amount of patient radiation exposure and satisfied the ethical considerations.…”

Artificial intelligence in echocardiography: detection, functional evaluation, and disease diagnosis

“…However, because of the dynamic changes in the position of aortic valves in vivo, 2D static image-based assessment is not only subjective but also only reveals the measurement results of one or two frames during the cardiac cycle. Some research studies [ 37 ] have adopted an automatic tracking algorithm based on anatomical affine optical flow for fast and automatic tracking of aortic valves and proximal end of the left ventricular outflow tract using 3D-TEE technology to optimize the measurement. It provides dynamic and accurate supporting information for preoperative planning of aortic valve replacement surgery, helping to improve the accuracy of valve evaluation and enhancing surgeon confidence.…”