Abstract：
BACKGROUND: New postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo-left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR).
OBJECTIVE: This study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT).
METHODS: A total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients.
RESULTS: There was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm2, limit of agreement: -92.2 mm2 to 143.3 mm2; P < 0.001; mean bias pre/post CT: 28.3 mm2, limit of agreement: -65.8 mm2 to 122.4 mm2; P = 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r2 = 0.481; P < 0.001 for TEE and r2 = 0.401; P < 0.001 for CT).
CONCLUSIONS: TEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.
OBJECTIVE: This study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT).
METHODS: A total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients.
RESULTS: There was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm2, limit of agreement: -92.2 mm2 to 143.3 mm2; P < 0.001; mean bias pre/post CT: 28.3 mm2, limit of agreement: -65.8 mm2 to 122.4 mm2; P = 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r2 = 0.481; P < 0.001 for TEE and r2 = 0.401; P < 0.001 for CT).
CONCLUSIONS: TEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.
摘要：
背景：新的后处理软件有助于三维（3D）超声心动图确定接受经导管二尖瓣置换术（TMVR）的患者的二尖瓣环（MA）和新左心室流出道（neo-LVOT）尺寸。
目的：本研究旨在测试3D超声心动图分析与基线计算机断层扫描（CT）的准确性。
方法：回顾性纳入了2017年10月至2023年5月在2个三级护理中心接受TMVR的105例连续患者。使用专用软件在基线CT和3D经食管超声心动图（TEE）中投射虚拟瓣膜。在基线图像中测量MA尺寸,并且在基线和术后图像中测量新LVOT尺寸。将所有测量值与作为参考的基线CT进行比较。预测的新LVOT面积与术后峰值LVOT梯度相关。
结果：两种成像方式之间的基线新LVOT预测没有显著偏差。TEE明显低估了MA地区，周边,与CT相比，内侧-外侧尺寸。两种模式都显着低估了实际的新LVOT面积（TEE前/后平均偏差：25.6mm2，一致极限：-92.2mm2至143.3mm2；P<0.001；CT前/后平均偏差：28.3mm2，一致极限：-65.8mm2至122.4mm2；P=0.046），在使用专用二尖瓣生物假体治疗的组中，新LVOT低估了。CT和TEE预测的新LVOT区域均与术后LVOT梯度呈负相关（r2=0.481；TEE和r2=0.401P<0.001；CTP<0.001）。
结论：TEE衍生的分析在预测TMVR后的新LVOT面积和峰值梯度方面提供了与CT衍生的指标相当的结果。
目的：本研究旨在测试3D超声心动图分析与基线计算机断层扫描（CT）的准确性。
方法：回顾性纳入了2017年10月至2023年5月在2个三级护理中心接受TMVR的105例连续患者。使用专用软件在基线CT和3D经食管超声心动图（TEE）中投射虚拟瓣膜。在基线图像中测量MA尺寸,并且在基线和术后图像中测量新LVOT尺寸。将所有测量值与作为参考的基线CT进行比较。预测的新LVOT面积与术后峰值LVOT梯度相关。
结果：两种成像方式之间的基线新LVOT预测没有显著偏差。TEE明显低估了MA地区，周边,与CT相比，内侧-外侧尺寸。两种模式都显着低估了实际的新LVOT面积（TEE前/后平均偏差：25.6mm2，一致极限：-92.2mm2至143.3mm2；P<0.001；CT前/后平均偏差：28.3mm2，一致极限：-65.8mm2至122.4mm2；P=0.046），在使用专用二尖瓣生物假体治疗的组中，新LVOT低估了。CT和TEE预测的新LVOT区域均与术后LVOT梯度呈负相关（r2=0.481；TEE和r2=0.401P<0.001；CTP<0.001）。
结论：TEE衍生的分析在预测TMVR后的新LVOT面积和峰值梯度方面提供了与CT衍生的指标相当的结果。
