Comparative measurement of aortic root by transthoracic echocardiography in normal Korean population based on two different guidelines

Abstract

BackgroundAortic root size is an important parameter in vascular diseases and can be easily assessed by transthoracic echocardiography. However, measurements values may vary according to cardiac cycle and the definition used for edge. This study aimed to define normal values according to the measurement method specified by two different guidelines to determine the influence of the different methods on echocardiographic measurements.MethodsHealthy Korean adults were enrolled. The aortic root diameters were measured twice at four levels (aortic annulus, sinuses of Valsalva, sinotubular junction, and ascending aorta) by the 2005 American Society of Echocardiography (ASE) guidelines (measured from leading edge to leading edge during diastole) and the 2010 ASE pediatric guidelines (measured from inner edge to inner edge during systole).ResultsOne hundred twelve subjects aged 20–69 years were enrolled. The aortic diameters (cm) determine by the aforementioned two guidelines showed significant difference. Measurements were larger in 2005 ASE guideline at aortic annuls, sinuses of Valsalva, and sinotubular junction level, but smaller at ascending aortic level with 2-3mm of differences. Intraobserver variability was similarly good, but interobserver variability was slightly higher than intraobserver variability in both measurement methods. BSA and age was most important determinant for aortic root size.ConclusionsThe measurement method of aortic root can affect the echocardiographic result. The measurement method should be noted when assessing clinical significance of aortic root measurement.

Aortic dimensions by multi-detector computed tomography vs. echocardiography

“…We are not aware of any study that compared measurements obtained by the three common methods of measurement (INT, MIX, or EXT) to those obtained by the corresponding modality. A previous study compared two methods for measuring aortic dimensions (MIX and INT) at four locations along the ascending aorta, however it was an ECHO study which did not compare the measurements to those obtained by MDCT [7]. The current study was intended to fill in these lacking data.…”

“…Much interest has lately risen in comparing aortic annular dimensions obtained by MDCT vs. ECHO because of the implementation of the transcatheter aortic valve implantation technique which requires accurate determinations of the aortic annular diameter. These studies were limited to comparing measurements derived from both modalities at only the ANN location as performed by one method only [7][8][9][10][11]. The general conclusion is that there is a good correlation between both modalities at that specific location.…”

“…Attention has been given to differences between systolic vs. diastolic aortic dimensions [1,[4][5][6], and the influence of gender, age, and body surface area by each modality [5,7,8]. However, we are aware of only one study that compared ECHO and MDCT measurements of the aorta at multiple locations.…”

The Need for Standardized Methods for Measuring the Aorta

“…(14, 15) Importantly, recent data suggest that this difference in measurement techniques may not be as large as initially thought and therefore not as clinically significant on its own. (16) In our study, all GenTAC centers acquired images following ASE guidelines and 5 of the 6 centers measured according to the end systole, inner to-inner edge technique, which was also the chosen technique for the central iCORE. This situation probably accounts for the high reproducibility of echo for aortic segments up to the ascending aorta.…”

Proximal thoracic aortic diameters: transesophageal-echocardiography- versus computed-tomography-derived measurements

“…Similarly for echocardiography, while the American Society of Echocardiography advocated a leading edge technique in diastole for measurement, the recent independently developed pediatric guidelines suggest using inner to inner edge in peak expansion (systole) (15). Since several aortic diseases have a genetic basis and patient care often transitions from pediatric to adult cardiologists, such differences in aortic measurement technique can become relevant (16). The guidelines for diagnosis and management of patients with thoracic aortic disease recommends using external diameters on CT and internal diameters on echocardiography (17).…”