Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography
| Autor: | Yue-Jian Kang, J. Luis Guerrero, Mary Flaherty, Liang Shen, Jorge Solis, Robert A. Levine, Judy Hung, Kian Keong Poh |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Aortic valve medicine.medical_specialty Echocardiography Three-Dimensional Doppler echocardiography Sensitivity and Specificity Ventricular Function Left Clinical Research Heart Rate Internal medicine medicine.artery medicine Animals Humans Ventricular outflow tract Prospective Studies Aged Observer Variation Aorta Sheep medicine.diagnostic_test business.industry valvular heart disease Reproducibility of Results Stroke Volume Aortic Valve Stenosis Stroke volume medicine.disease Stenosis medicine.anatomical_structure Aortic Valve Aortic valve stenosis Cardiology Female Cardiology and Cardiovascular Medicine business Blood Flow Velocity |
| Zdroj: | European Heart Journal. 29:2526-2535 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehn022 |
| Popis: | Aims Two-dimensional echocardiographic (2DE) continuity-equation derived aortic valve area (AVA) in aortic stenosis (AS) relies on non-simultaneous measurement of left ventricular outflow tract (LVOT) velocity and geometric assumptions of LVOT area, which can amplify error, especially in upper septal hypertrophy (USH). We hypothesized that real-time three-dimensional echocardiography (RT3DE) can improve accuracy of AVA by directly measuring LVOT stroke volume (SV) in one window. Methods and results RT3DE colour Doppler and 2DE were acquired in 68 AS patients (74 ± 12 yrs) prospectively. SV was derived from flow obtained from a sampling curve placed orthogonal to LVOT (Tomtec Imaging). Agreement between continuity-equation derived AVA by RT3DE (AVA3D-SV) and 2DE (AVA2D) and predictors of discrepancies were analysed. Validation of LVOT SV was performed by aortic flow probe in a sheep model with balloon inflation of septum to mimic USH. There was only modest correlation between AVA2D and AVA3D-SV ( r = 0.71, difference 0.11 ± 0.23 cm2). The degree of USH was significantly associated with difference in AVA calculation ( r = 0.4, P = 0.005). In experimentally distorted LVOT geometry in sheep, RT3DE correlated better with flow probe assessment ( r = 0.96, P < 0.001) than 2DE ( r = 0.71, P = 0.006). Conclusion RT3DE colour Doppler-derived LVOT SV in the calculation of AVA by continuity equation is more accurate than 2D, including in situations such as USH, common in the elderly, which modify LVOT geometry. |
| Databáze: | OpenAIRE |
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