title: Quantitative assessment of aortic stenosis by three-dimensional anyplane and three-dimensional volume-rendered echocardiography.
abstract: Aortic stenosis is a challenge for three-dimensional (3-D) echocardiographic image resolution. This is the first study evaluating both 3-D anyplane and 3-D volume-rendered echocardiography in the quantification of aortic stenosis. In 31 patients, 3-D echocardiography was performed using a multiplane transesophageal probe. Within the acquired volume dataset, five parallel cross sections were generated through the aortic valve. Subsequently, volume-rendered images of the five cross sections were reconstructed. The smallest orifice areas of both series were compared with the results obtained by two-dimensional (2-D) transesophageal planimetry and those calculated by Doppler continuity equation. No significant differences were found between Doppler (0.76 +/- 0.18 cm(2)), 2-D echocardiography (0.78 +/- 0.24 cm(2)), and 3-D anyplane echocardiography (0.72 +/- 0.29 cm(2)). The orifice area measured smaller (0.54 =/- 0.31 cm(2), P < 0.001) by 3-D volume-rendered echocardiography. Bland-Altmann analysis indicated that for 3-D anyplane echocardiography, the mean difference from Doppler and 2-D echocardiography was - 0.04 +/- 0.24 cm(2) and - 0.06 +/- 0.23 cm(2), respectively. For 3-D volume-rendered echocardiography, the mean difference was -0.23 +/- 0.24 cm(2) and - 0.25 +/- 0.26 cm(2), respectively. In the subgroup with good resolution in the 3-D dataset, close limits of agreement were obtained between 3-D echocardiography and each of the reference methods, while the subgroup with poor resolution showed wide limits of agreement. In conclusion, planimetry of the stenotic aortic orifice by 3-D volume-rendered echocardiography is feasible but tends to underestimate the orifice area. Three-dimensional anyplane echocardiography shows better agreement with the reference methods. Accuracy is influenced strongly by the structural resolution of the stenotic orifice in the 3-D dataset.
authors.affiliation: Department of Cardiology and Angiology, Alberts Ludwigs University Freiburg, Freiburg, Germany. handke@ukl.uni-freiburg.de
authors.forename: Michael
authors.initials: M
authors.lastname: Handke
authors.forename: Dietrich Markus
authors.initials: DM
authors.lastname: Schäfer
authors.forename: Gudrun
authors.initials: G
authors.lastname: Heinrichs
authors.forename: Etsuko
authors.initials: E
authors.lastname: Magosaki
authors.forename: Annette
authors.initials: A
authors.lastname: Geibel
mesh_terms: D000328:Adult; D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric