Reproducibility of Doppler echocardiographic quantification of aortic and mitral valve stenoses: Comparison between two echocardiography centers

Geibel, Annette; Görnandt, L.; Kasper, Wolfgang; Bubenheimer, P.

doi:10.1016/0002-9149(91)90176-l

Cited by 44 publications

(20 citation statements)

References 28 publications

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“…This is in line with previous studies in patients with aortic valve stenosis [51] and in other patients with cardiac disease [20]. Of note, animal studies have shown that LVOT VTI is an effective and noninvasive method when assessing LV systolic function under conditions of varying preload, heart rate, and inotropic state [21,22,52], an important asset in hemodynamically unstable patients.…”

Section: Discussionsupporting

confidence: 88%

Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care

et al. 2011

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IntroductionAssessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE).MethodsFifty patients with shock and mechanical ventilation were included. TTE examinations were performed daily for a total of 7 days. Methods used to assess LV systolic function were visually estimated, "eyeball" ejection fraction (EBEF), the Simpson single-plane method, mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs), and velocity time integral in the left ventricular outflow tract (VTI).ResultsEBEF, AVPDm, TDIs, VTI, and the Simpson were obtained in 100%, 100%, 99%, 95% and 93%, respectively, of all possible examinations. The correlations between the Simpson and EBEF showed r values for all 7 days ranging from 0.79 to 0.95 (P < 0.01). the Simpson correlations with the other LV parameters showed substantial variation over time, with the poorest results seen for TDIs and AVPDm. The repeatability was best for VTI (interobserver coefficient of variation (CV) 4.8%, and intraobserver CV, 3.1%), and AVPDm (5.3% and 4.4%, respectively), and worst for the Simpson method (8.2% and 10.6%, respectively).ConclusionsEBEF and AVPDm provided the best, and Simpson, the worst feasibility when assessing LV systolic function in a population of mechanically ventilated, hemodynamically unstable patients. Additionally, the Simpson showed the poorest repeatability. We suggest that EBEF can be used instead of single-plane Simpson when assessing LV ejection fraction in this category of patients. TDIs and AVPDm, as markers of longitudinal function of the LV, are not interchangeable with LV ejection fraction.

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Section: Discussionsupporting

confidence: 88%

Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care

et al. 2011

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“…Although used widely and largely validated, the measurements required are sometimes difficult to obtain with accuracy [4]. Suboptimal parasternal and apical windows may lead to inaccurate measurements of the left ventricular outflow diameter, left ventricular outflow velocity and aortic valve gradients, thus resulting in higher inter-and intra-observer variability of aortic valve gradients and aortic valve area [5,6]. Due to these limitations, direct planimetry of the AVA with transesophageal echocardiography (TEE) is often required to assess AVA and along with direct hemodynamic measurements in the cardiac catheterization laboratory are considered the gold standard for determining aortic valve severity [7,8].…”

Section: Introductionmentioning

confidence: 99%

Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography

Shah

Novaro

Blandon

et al. 2009

Int J Cardiovasc Imaging

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Degenerative aortic valve stenosis (AS) has an incidence of 2-7% in the Western European and North American populations over 65 years of age. The aim of this study was to perform a meta-analysis of the published literature evaluating the accuracy of CT planimetry to measure the aortic valve area. The PUBMED and OVID databases were searched up to May 2008. Major criteria for article inclusion was the use of (a) multi-detector computed tomography as a diagnostic test for the assessment of AVA in patients with AS, and (b) TTE as the reference standard. Nine studies were included in the analysis with 175 women and 262 men. The mean AVA as measured by CT was 1.0 +/- 0.1. The mean AVA measured by TTE was 0.9 +/- 0.1. The correlation between CT and TTE AVA measurements was r = 1.45. The mean difference was 0.03 +/- 0.05. The results of our meta-analysis suggest that multi-detector CT is an accurate method for obtaining AVA measurements in patients with AS.

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“…[3][4][5] However, in many cases the use of TTE is limited by poor acoustic windows and erroneous calculations caused by annulus calcification or eccentric jet morphology. [3][4][5][6][7][8][9] Thus, invasive confirmation of echocardiographic measurements is still routinely used in many institutions before valve replacement surgery. For this purpose, semi-invasive AVA planimetry based on transoesophageal echocardiography (TOE) and invasive cardiac catheterisation evaluating AVA by applying the Gorlin formula are available.…”

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confidence: 99%

Evaluation of aortic stenosis by cardiovascular magnetic resonance imaging: comparison with established routine clinical techniques

Kupfahl

Honold²,

Meinhardt³

et al. 2004

Heart

139

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Objective: To evaluate whether direct planimetry of aortic valve area (AVA) by cardiac magnetic resonance (CMR) imaging is a reliable tool for determining the severity of aortic stenosis compared with transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), and cardiac catheterisation. Methods: 44 symptomatic patients with severe aortic stenosis were studied. By cardiac catheterisation AVA was calculated by the Gorlin equation. AVA was measured with CMR from steady state free precession (true fast imaging with steady state precession) by planimetry. AVA was also determined from TOE images by planimetry and from TTE images by the continuity equation. Results: Bland-Altman analysis evaluating intraobserver and interobserver variability showed a very small bias for both (20.016 and 0.019, respectively; n = 20). Bias and limits of agreement between CMR and TTE were 0.05 (20.35, 0.44) cm 2 (n = 37), between CMR and TOE 0.02 (20.39, 0.42) cm 2 (n = 32), and between CMR and cardiac catheterisation 0.09 (20.30, 0.47) cm 2 (n = 36). The sensitivity and specificity of CMR to detect AVA ( 0.80 cm 2 measured by cardiac catheterisation was 78% and 89%, of TOE 70% and 70%, and of TTE 74% and 67%, respectively. Conclusion: CMR planimetry is highly reliable and reproducible. Further, CMR planimetry had the best sensitivity and specificity of all non-invasive methods for detecting severe aortic stenosis in comparison with cardiac catheterisation. Therefore, CMR planimetry of AVA with steady state free precession is a new powerful diagnostic tool, particularly for patients with uncertain or discrepant findings by other modalities.

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Reproducibility of Doppler echocardiographic quantification of aortic and mitral valve stenoses: Comparison between two echocardiography centers

Cited by 44 publications

References 28 publications

Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care

Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care

Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography

Evaluation of aortic stenosis by cardiovascular magnetic resonance imaging: comparison with established routine clinical techniques

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