Fully automated software for mitral annulus evaluation in chronic mitral regurgitation by 3-dimensional transesophageal echocardiography

Abstract

Three-dimensional (3D) transesophageal echocardiography (TEE) is the gold standard for mitral valve (MV) anatomic and functional evaluation. Currently, dedicated MV analysis software has limitations for its use in clinical practice. Thus, we tested here a complete and reproducible evaluation of a new fully automatic software to characterize MV anatomy in different forms of mitral regurgitation (MR) by 3D TEE.Sixty patients were included: 45 with more than moderate MR (28 organic MR [OMR] and 17 functional MR [FMR]) and 15 controls. All patients underwent TEE. 3D MV images obtained using 3D zoom were imported into the new software for automatic analysis. Different MV parameters were obtained and compared. Anatomic and dynamic differences between FMR and OMR were detected. A significant increase in systolic (859.75 vs 801.83 vs 607.78 mm2; P = 0.002) and diastolic (1040.60 vs. 1217.83 and 859.74 mm2; P < 0.001) annular sizes was observed in both OMR and FMR compared to that in controls. FMR had a reduced mitral annular contraction compared to degenerative cases of OMR and to controls (17.14% vs 32.78% and 29.89%; P = 0.007). Good reproducibility was demonstrated along with a short analysis time (mean 4.30 minutes).Annular characteristics and dynamics are abnormal in both FMR and OMR. Full 3D software analysis automatically calculates several significant parameters that provide a correct and complete assessment of anatomy and dynamic mitral annulus geometry and displacement in the 3D space. This analysis allows a better characterization of MR pathophysiology and could be useful in designing new devices for MR repair or replacement.

Automated Spectral Doppler Profile Tracing

“…10 Automation also has been demonstrated in the assessment of mitral and AV disease with good reproducibility. 8,[18][19][20] In regards to Doppler technology, an approach involving thresholding based on the signal/noise ratio has been described in transthoracic echocardiography for online analysis of CW Doppler data. 26 More recently, a method for spectral envelope estimation that is fully automatic and independent of gain settings was described for vascular studies of uterine, umbilical, carotid, and subclavian arteries.…”

“…Automated software has been developed for complex threedimensional valve analysis and chamber quantification, for example. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] However, a significant portion of the echocardiographic examination continues to be performed manually.…”

Automation, machine learning, and artificial intelligence in echocardiography: A brave new world

“…Limitations described were the need for manual placement of initial markers on the four mitral annular reference points, the aorta, the coaptation nadir, and leaflet coaptation points around the annulus to delineate the line of coaptation from which a semiautomatic annular track would be initiated and the topographic map of the MV would be generated, as well as the presence of specific annular pathology that the software did not recognize. An automated software program was used by Aquila et al (eSie Valves, Autovalve prototype version 1.22, Siemens Medical Solutions, USA) to evaluate its feasibility in analyzing mitral annulus dynamics in functional and organic MR . This full 3D software analysis automatically calculated several MV parameters such as annular area, annular height, anteroposterior and anterolateral–posteromedial diameter, inter‐trigonal distance, total leaflet area, and nonplanarity angle scalar.…”

Role of Cardiac Imaging: Echocardiography

“…Conversely, 2D echocardiography approach from the four-chamber view significantly underestimated RVol (r = 0.006) as compared with CMR (mean difference = 2.9 mL/beat) [73]. Currently, dedicated MV analysis softwares allow a fast, complete, and reproducible evaluation of MV anatomy and function (MV annulus dimensions, MV annulus displacement, MV leaflet surface, tenting volume, aortomitral angle, and papillary muscle geometry) [74][75][76]. Furthermore, 3D transesophageal echocardiography plays an important role in the selection of patients for MitraClip, in the echocardiographic guidance of the procedure and in the pre-and post-procedural MR quantification [77].…”