背景:左心室流出道(ALVOT)的面积代表了连续性方程(CE)的主要组成部分,也就是说,i.a.,计算主动脉瓣(AV)面积(AAV)至关重要。ALVOT通常使用2D回波评估作为测量的前-后(a/p)延伸来计算,假设有一个圆形的LVOT基地。解剖学上,然而,通常存在椭圆形状的LVOT底座,长直径从内侧-外侧轴延伸(m/l),二维(2D)超声心动图无法识别。
目的:我们旨在比较标准和三维(3D)超声心动图衍生的ALVOT计算及其在标准CE(CEstd)和改良CE(CEmod)中计算AAV与解剖ALVOT的计算机断层扫描(CT)多平面重建(MPR)测量,和AAV,分别。
方法:选择3D经胸超声心动图(TTE),经食管三维超声心动图(TEE),心脏CT都做了,成像质量足够。ALVOT使用2D计算进行评估,(仅限A/P),3D体积MPR,和3D双平面计算(a/p和m/l)。使用CEstd和CEmod测量AAV,和3D体积MPR。将数据与相应的CT分析进行比较。
结果:从2017年到2018年,纳入了107例具有完整和充分影像学数据的连续患者。当通过2D评估时,与3D体积MPR和3D双平面计算两者相比,计算的ALVOT更小。与CEmod或3D体积MPR相比,CEstd中计算的AAV相应较小。ALVOT和AAV,使用3D超声心动图的数据,高度相关,并且与CT中的相应测量结果一致。
结论:由于LVOT的椭圆形,使用基于二维超声心动图的测量和计算系统地低估了ALVOT和依赖区域,例如AAV。使用3D超声心动图和适应性计算可以实现解剖学上的正确评估,比如CEmod。
BACKGROUND: The area of the left ventricular outflow tract (ALVOT) represents a major component of the continuity equation (CE), which is, i.a., crucial to calculate the aortic valve (AV) area (AAV). The ALVOT is typically calculated using 2D echo assessments as the measured anterior-posterior (a/p) extension, assuming a round LVOT base. Anatomically, however, usually an elliptical shape of the LVOT base is present, with the long diameter extending from the medial-lateral axis (m/l), which is not recognized by two-dimensional (2D) echocardiography.
OBJECTIVE: We aimed to compare standard and three-dimensional (3D)-echocardiography-derived ALVOT calculation and its use in a standard CE (CEstd) and a modified CE (CEmod) to calculate the AAV vs. computed tomography (CT) multi-planar reconstruction (MPR) measurements of the anatomical ALVOT, and AAV, respectively.
METHODS: Patients were selected if 3D transthoracic echocardiography (TTE), 3D transesophageal echocardiography (TEE), and cardiac CT were all performed, and imaging quality was adequate. The ALVOT was assessed using 2D calculation, (a/p only), 3D-volume MPR, and 3D-biplane calculation (a/p and m/l). AAV was measured using both CEstd and CEmod, and 3D-volume MPR. Data were compared to corresponding CT analyses.
RESULTS: From 2017 to 2018, 107 consecutive patients with complete and adequate imaging data were included. The calculated ALVOT was smaller when assessed by 2D- compared to both 3D-volume MPR and 3D-biplane calculation. Calculated AAV was correspondingly smaller in CEstd compared to CEmod or 3D-volume MPR. The ALVOT and AAV, using data from 3D echocardiography, highly correlated and were congruent with corresponding measurements in CT.
CONCLUSIONS: Due to the elliptic shape of the LVOT, use of measurements and calculations based on 2D echocardiography systematically underestimates the ALVOT and dependent areas, such as the AAV. Anatomically correct assessment can be achieved using 3D echocardiography and adapted calculations, such as CEmod.