title: Reproducibility of a novel echocardiographic 3D automated software for the assessment of mitral valve anatomy.
abstract: BACKGROUND
  3D transesophageal echocardiography (TEE) is superior to 2D TEE in quantitative anatomic evaluation of the mitral valve (MV) but it shows limitations regarding automatic quantification. Here, we tested the inter-/intra-observer reproducibility of a novel full-automated software in the evaluation of MV anatomy compared to manual 3D assessment.
  
  
  METHODS
  Thirty-six out of 61 screened patients referred to our Cardiac Imaging Unit for TEE were retrospectively included. 3D TEE analysis was performed both manually and with the automated software by two independent operators. Mitral annular area, intercommissural distance, anterior leaflet length and posterior leaflet length were assessed.
  
  
  RESULTS
  A significant correlation between both methods was found for all variables: intercommissural diameter (r = 0.84, p < 0.01), mitral annular area (r = 0.94, p > 0, 01), anterior leaflet length (r = 0.83, p < 0.01) and posterior leaflet length (r = 0.67, p < 0.01). Interobserver variability assessed by the intraclass correlation coefficient was superior for the automatic software: intercommisural distance 0.997 vs. 0.76; mitral annular area 0.957 vs. 0.858; anterior leaflet length 0.963 vs. 0.734 and posterior leaflet length 0.936 vs. 0.838. Intraobserver variability was good for both methods with a better level of agreement with the automatic software.
  
  
  CONCLUSIONS
  The novel 3D automated software is reproducible in MV anatomy assessment. The incorporation of this new tool in clinical MV assessment may improve patient selection and outcomes for MV interventions as well as patient diagnosis and prognosis stratification. Yet, high-quality 3D images are indispensable.
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain. aquila@unicz.it.|Cardiovascular Institute, Department of Medical and Surgical Sciences, Magna Graecia University, Campus S. Venuta, Viale Europa, Catanzaro, 88100, Italy. aquila@unicz.it.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Aquila
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
authors.forename: Ariana
authors.initials: A
authors.lastname: González
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernández-Golfín
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Rincón
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Casas
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: García
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Hinojar
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
authors.forename: José Julio
authors.initials: JJ
authors.lastname: Jiménez-Nacher
authors.affiliation: Cardiac Imaging Unit, Ramón y Cajal University Hospital, Carretera de Colmenar Km 9,100, 28034, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000368:Aged; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012984:Software
keywords: 3D echocardiography; Automatic software; Mitral valve