Utility of Angle Correction for Hemodynamic Measurements with Doppler Echocardiography
| Autor: | Nathan H. Waldron, Alina Nicoara, Madhav Swaminathan, Eun J. Eoh, Vinca Chow, Martin I. Sigurdsson, Jayne Cleve |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Hemodynamics Pilot Projects 030204 cardiovascular system & hematology Doppler echocardiography Cohort Studies 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology hemic and lymphatic diseases Monitoring Intraoperative Medicine Cutoff Humans Prospective Studies Prospective cohort study reproductive and urinary physiology Aged Retrospective Studies medicine.diagnostic_test business.industry Retrospective cohort study Middle Aged medicine.disease female genital diseases and pregnancy complications Confidence interval Echocardiography Doppler Stenosis Anesthesiology and Pain Medicine Female Cardiology and Cardiovascular Medicine business Nuclear medicine Echocardiography Transesophageal Cohort study |
| Zdroj: | Journal of cardiothoracic and vascular anesthesia. 32(4) |
| ISSN: | 1532-8422 |
| Popis: | Objectives The routine application angle correction (AnC) in hemodynamic measurements with transesophageal echocardiography currently is not recommended but potentially could be beneficial. The authors hypothesized that AnC can be applied reliably and may change grading of aortic stenosis (AS). Design Retrospective analysis. Setting Single institution, university hospital. Participants During phase I, use of AnC was assessed in 60 consecutive patients with intraoperative transesophageal echocardiography. During phase II, 129 images from a retrospective cohort of 117 cases were used to quantify AS by mean pressure gradient. Interventions A panel of observers used custom-written software in Java to measure intra-individual and inter-individual correlation in AnC application, correlation with preoperative transthoracic echocardiography gradients, and regrading of AS after AnC. Measurements and Main Results For phase I, the median AnC was 21 (16-35) degrees, and 17% of patients required no AnC. For phase II, the median AnC was 7 (0-15) degrees, and 37% of assessed images required no AnC. The mean inter-individual and intra-individual correlation for AnC was 0.50 (95% confidence interval [CI] 0.49-0.52) and 0.87 (95% CI 0.82-0.92), respectively. AnC did not improve agreement with the transthoracic echocardiography mean pressure gradient. The mean inter-rater and intra-rater agreement for grading AS severity was 0.82 (95% CI 0.81-0.83) and 0.95 (95% CI 0.91-0.95), respectively. A total of 241 (7%) AS gradings were reclassified after AnC was applied, mostly when the uncorrected mean gradient was within 5 mmHg of the severity classification cutoff. Conclusions AnC can be performed with a modest inter-rater and intra-rater correlation and high degree of inter-rater and intra-rater agreement for AS severity grading. |
| Databáze: | OpenAIRE |
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