Accuracy of Three-Dimensional Versus Two-Dimensional Echocardiography for Quantification of Aortic Regurgitation and Validation by Three-Dimensional Three-Directional Velocity-Encoded Magnetic Resonance Imaging

Quantitative assessment of aortic regurgitation (AR) remains challenging. The present study evaluated the accuracy of 2-dimensional (2D) and 3-dimensional (3D) transthoracic echocardiography (TTE) for AR quantification, using 3D 3-directional velocity-encoded magnetic resonance imaging (VE-MRI) as t...

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Bibliographic Details
Published in:The American journal of cardiology 2013-08, Vol.112 (4), p.560-566
Main Authors: Ewe, See Hooi, MBBS, Delgado, Victoria, MD, PhD, van der Geest, Rob, MSc, PhD, Westenberg, Jos J.M., PhD, Haeck, Marlieke L.A., MD, Witkowski, Tomasz G., MD, Auger, Dominique, MD, Marsan, Nina Ajmone, MD, Holman, Eduard R., MD, PhD, de Roos, Albert, MD, PhD, Schalij, Martin J., MD, PhD, Bax, Jeroen J., MD, PhD, Sieders, Allard, MD, Siebelink, Hans-Marc J., MD, PhD
Format: Article
Language:English
Subjects:
Accuracy
Aortic Valve Insufficiency - diagnostic imaging
Blood pressure
Cardiology
Cardiovascular
Cardiovascular disease
Chi-Square Distribution
Comorbidity
Confidence intervals
Coronary vessels
Echocardiography
Echocardiography, Doppler, Color
Echocardiography, Three-Dimensional
Female
Heart
Heart rate
Humans
Image Processing, Computer-Assisted
Imaging, Three-Dimensional
Linear Models
Magnetic Resonance Imaging - methods
Male
Middle Aged
NMR
Nuclear magnetic resonance
Patients
Retrospective Studies
Severity of Illness Index
Software
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Summary:Quantitative assessment of aortic regurgitation (AR) remains challenging. The present study evaluated the accuracy of 2-dimensional (2D) and 3-dimensional (3D) transthoracic echocardiography (TTE) for AR quantification, using 3D 3-directional velocity-encoded magnetic resonance imaging (VE-MRI) as the reference method. Thirty-two AR patients were included. With color Doppler TTE, 2D effective regurgitant orifice area (EROA) was calculated using the proximal isovelocity surface area method. From the 3D TTE multiplanar reformation data, 3D-EROA was calculated by planimetry of the vena contracta. Regurgitant volumes (RVol) were obtained by multiplying the 2D-EROA and 3D-EROA by the velocity-time integral of AR jet and compared with that obtained using VE-MRI. For the entire population, 3D TTE RVol demonstrated a strong correlation and good agreement with VE-MRI RVol (r = 0.94 and −13.6 to 15.6 ml/beat, respectively), whereas 2D TTE RVol showed a modest correlation and large limits of agreement with VE-MRI (r = 0.70 and −22.2 to 32.8 ml/beat, respectively). Eccentric jets were noted in 16 patients (50%). In these patients, 3D TTE demonstrated an excellent correlation (r = 0.95) with VE-MRI, a small bias (0.1 ml/beat) and narrow limits of agreement (−18.7 to 18.8 ml/beat). Finally, the kappa agreement between 3D TTE and VE-MRI for grading of AR severity was good (k = 0.96), whereas the kappa agreement between 2D TTE and VE-MRI was suboptimal (k = 0.53). In conclusion, AR RVol quantification using 3D TTE is accurate, and its advantage over 2D TTE is particularly evident in patients with eccentric jets.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2013.04.025