Assessment of aortic valve tract dynamics using automatic tracking of 3D transesophageal echocardiographic images

The myth of aortic valve annulus changes in aortic valve disease

Background

The characteristics of aortic annulus changes in aortic regurgitation (AR) patients are poorly understood, and predictive factors among aortic valve disease are yet to be established.

Objective

This study seeks to elucidate the pattern of annular size fluctuations across different cardiac phases in AR patients and to identify predictors for annular enlargement during either systole or diastole in aortic valve diseases.

Methods

A retrospective analysis was conducted on 55 patients with severe aortic valve diseases, including 26 patients with aortic stenosis (AS) and 29 with AR, to discern the two groups' contrasting and analogous patterns of annular changes. The patient sample was expanded to 107 to investigate the factors influencing the size of the annulus during different cardiac phases. Based on our findings, patients were then divided into two groups: those with an annulus that is larger during systole (83 patients) and those where the annulus is larger during diastole (24 patients).

Results

Typically, AR patients exhibit a dynamic annulus, with both perimeter and area being largest during mid-systole. These dimensions diminish progressively and then increase again in early diastole, a pattern consistent with observations in AS patients. Among 107 patients, 21% had diastolic enlargement. Systolic measurements would lead to prosthesis undersizing in 17% of these. Male gender and lower systolic annulus minimum relative to body surface area (AnMin index) were predictors of diastolic enlargement, with ROC curve areas of 0.70 and 0.87 for AR and AS, respectively.

Conclusions

Systolic measurements are recommended for AR patients. Gender and the AnMin index are significant predictors, particularly potent in AS patients.

Artificial intelligence in echocardiography: detection, functional evaluation, and disease diagnosis

Ultrasound is one of the most important examinations for clinical diagnosis of cardiovascular diseases. The speed of image movements driven by the frequency of the beating heart is faster than that of other organs. This particularity of echocardiography poses a challenge for sonographers to diagnose accurately. However, artificial intelligence for detection, functional evaluation, and disease diagnosis has gradually become an alternative for accurate diagnosis and treatment using echocardiography. This work discusses the current application of artificial intelligence in echocardiography technology, its limitations, and future development directions.

Aortic Annular Sizing Using Novel Software in Three-Dimensional Transesophageal Echocardiography for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

(1) Background: We performed this study to evaluate the agreement between novel automated software of three-dimensional transesophageal echocardiography (3D-TEE) and multidetector computed tomography (MDCT) for aortic annular measurements of preprocedural transcatheter aortic valve replacement (TAVR); (2) Methods: PubMed, EMBASE, Web of Science, and Cochrane Library (Wiley) databases were systematically searched for studies that compared 3D-TEE and MDCT as the reference standard for aortic annular measurement of the following parameters: annular area, annular perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter. Meta-analytic methods were utilized to determine the pooled correlations and mean differences between 3D-TEE and MDCT. Heterogeneity and publication bias were also assessed. Meta-regression analyses were performed based on the potential factors affecting the correlation of aortic annular area; (3) Results: A total of 889 patients from 10 studies were included in the meta-analysis. Pooled correlation coefficients between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were strong 0.89 (95% CI: 0.84–0.92), 0.88 (95% CI: 0.83–0.92), 0.87 (95% CI: 0.77–0.93), 0.87 (95% CI: 0.77–0.93), 0.79 (95% CI: 0.64–0.87), and 0.75 (95% CI: 0.61–0.84) (Overall p < 0.0001), respectively. Pooled mean differences between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were −20.01 mm² ((95% CI: −35.37 to −0.64), p = 0.011), −2.31 mm ((95% CI: −3.31 to −1.31), p < 0.0001), −0.22 mm ((95% CI: −0.73 to 0.29), p = 0.40), −0.47 mm ((95% CI: −1.06 to 0.12), p = 0.12), −1.36 mm ((95% CI: −2.43 to −0.30), p = 0.012), and 0.31 mm ((95% CI: −0.15 to 0.77), p = 0.18), respectively. There were no statistically significant associations with the baseline patient characteristics of sex, age, left ventricular ejection fraction, mean transaortic gradient, and aortic valve area to the correlation between 3D-TEE and MDCT for aortic annular area sizing; (4) Conclusions: The present study implies that 3D-TEE using novel software tools, automatically analysis, is feasible to MDCT for annulus sizing in clinical practice.

Accuracy of three-dimensional echocardiography in candidates for transcatheter aortic valve replacement

The correct determination of aortic annulus dimensions is a crucial step to avoid complications in Transcatheter Aortic Valve Replacement (TAVR). Currently, the gold standard method for the evaluation of the aortic annulus is Multidetector Computed Tomography (MDCT), which is limited by the risk of contrast-induced nephropathy. Three-dimensional transesophageal echocardiography automated software (3DTEEa) have been used as an alternative in patients with contra-indications to MDCT. We aimed to evaluate the accuracy of 3DTEEa-derived aortic annulus dimensions; to assess the influence of calcification in the agreement between 3DTEEa and MDCT; and to determine reclassification in prosthesis size choice if 3DTEEa was the only imaging method. One hundred and seven consecutive patients referred for TAVR were studied. Aortic annulus dimensions were determined using MDCT and 3DTEE manual (3DTEEm) and automated measurements. Valve calcification was assessed with MDCT. Limits of agreement (LOA) were narrower for 3DTEEa (minimum diameter: mean bias 0.60; LOA - 2.94 to 4.14; maximum diameter: mean bias 0.20; LOA - 3.82 to 4.22) as compared to 3DTEEm (minimum diameter: mean bias 0.22; LOA - 3.84 to 4.28; maximum diameter: mean bias - 1.25; LOA - 6.37; 3.86). Compared to MDCT, 3DTEEa overestimated while 3DTEEm underestimated most parameters. No differences were found in average bias between methods according to quartiles of valve calcification. Most patients would have received the same size valve (63.9%) if 3DTEEa was the only available method. Measurement of aortic annulus dimensions using a 3DTEE automatic software is feasible and not influenced by valve calcification. It may be an alternative for patients who cannot undergo MDCT.