Quantitative Assessment of Aortic Stenosis by Three‐Dimensional Anyplane and Three‐Dimensional Volume‐Rendered Echocardiography

Abstract

Aortic stenosis is a challenge for three-dimensional (3-D) echocardiographic image resolution. This is the first study evaluating both 3-D anyplane and 3-D volume-rendered echocardiography in the quantification of aortic stenosis. In 31 patients, 3-D echocardiography was performed using a multiplane transesophageal probe. Within the acquired volume dataset, five parallel cross sections were generated through the aortic valve. Subsequently, volume-rendered images of the five cross sections were reconstructed. The smallest orifice areas of both series were compared with the results obtained by two-dimensional (2-D) transesophageal planimetry and those calculated by Doppler continuity equation. No significant differences were found between Doppler (0.76 +/- 0.18 cm(2)), 2-D echocardiography (0.78 +/- 0.24 cm(2)), and 3-D anyplane echocardiography (0.72 +/- 0.29 cm(2)). The orifice area measured smaller (0.54 =/- 0.31 cm(2), P < 0.001) by 3-D volume-rendered echocardiography. Bland-Altmann analysis indicated that for 3-D anyplane echocardiography, the mean difference from Doppler and 2-D echocardiography was - 0.04 +/- 0.24 cm(2) and - 0.06 +/- 0.23 cm(2), respectively. For 3-D volume-rendered echocardiography, the mean difference was -0.23 +/- 0.24 cm(2) and - 0.25 +/- 0.26 cm(2), respectively. In the subgroup with good resolution in the 3-D dataset, close limits of agreement were obtained between 3-D echocardiography and each of the reference methods, while the subgroup with poor resolution showed wide limits of agreement. In conclusion, planimetry of the stenotic aortic orifice by 3-D volume-rendered echocardiography is feasible but tends to underestimate the orifice area. Three-dimensional anyplane echocardiography shows better agreement with the reference methods. Accuracy is influenced strongly by the structural resolution of the stenotic orifice in the 3-D dataset.

Valvular heart disease – stenoses

“…However, as mentioned above, visualization of the aortic valve using currently available transthoracic matrix array transducer technology is limited, thus, preventing AVA determination in most patients. Therefore, most studies that examined the role of 3D echocardiography in aortic stenosis have been performed using the [45] confirmed that planimetry of the 3D aortic valve opening area is feasible and accurate using reconstructive 3D TEE, compared with 2D TEE-based data and invasive measurements. More recently, feasibility of RT3D TEE in the direct assessment of AVA in patients with aortic stenosis was validated in several studies [46] [47].…”

Impact of three-dimensional echocardiography in valvular heart disease

“…Image quality can be affected by motion artifact from probe movement. The complete process of data acquisition, storage, post processing, volume-rendered reconstruction, and measurements can take up to an hour per patient [34] making it somewhat impractical for day-to-day use.…”

Three-Dimensional Echo: Transition from Theory to Real-Time, A Technology Now Ready for Prime Time

“…Similar to linear techniques, rotational 3DE has demonstrated the ability to reliably reproduce detailed anatomic structures through both transthoracic and transesophageal approaches. 76,77,[83][84][85]87,89,90,[93][94][95][96] Salustri and coworkers undertook an evaluation of a variety of congenital defects comparing 3DE to 2DE and found that 3DE provided additional clinical information in 36% of patients. 76 The role of rotational 3DE has been investigated in specific congenital heart defects as well.…”

“…96,[109][110][111][112] Ge and coworkers measured orifice areas of the aortic valve by planimetry using rotational 3D TEE in patients with aortic stenosis and compared them to values obtained in the same patients using standard 2D TEE. 3D measurements showed no significant difference from aortic valve areas calculated by both the Gorlin formula (⌬ ϭ 0.1 Ϯ 0.3 cm 2 , P ϭ 0.3) and the Doppler continuity equation (⌬ ϭ Ϫ0.0 Ϯ 0.3 cm 2 , P ϭ 0.7).…”