Juan I. Cotella MD , Alexandra Blitz MS , Alexandra Clement MD , Michele Tomaselli MD , Denisa Muraru MD , Luigi P. Badano MD , Natascha Sauber MS , Adria Font Calvarons MS , Markus Degel MS , Agnieszka Rucki PhD , Michael Blankenhagen MS , Megan Yamat BS , Marcus Schreckenberg MS , Karima Addetia MD , Federico M. Asch MD , Victor Mor-Avi PhD , Roberto M. Lang MD
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引用次数: 0
Abstract
Background
The expansion of tricuspid valve (TV) interventions has underscored the need for accurate and reproducible three-dimensional (3D) transthoracic echocardiographic (TTE) tools for evaluating the tricuspid annulus and for 3D normal values of this structure. The aims of this study were to develop new semi-automated software for 3D TTE analysis of the tricuspid annulus, compare its accuracy and reproducibility against those of multiplanar reconstruction (MPR) reference, and determine normative values.
Methods
Three-dimensional TTE images of 113 patients with variable degrees of tricuspid regurgitation were analyzed using the new semiautomated software and conventional MPR methodology (as the reference standard), each by three independent readers. For each measured parameter, intertechnique agreement was assessed using linear regression and Bland-Altman analyses, and interreader variability using intraclass correlation coefficients and coefficients of variation. Additionally, 3D TTE data sets of 789 subjects from the WASE (World Alliance Societies of Echocardiography) study were analyzed using this new software to determine normal values for each tricuspid annular (TA) parameter.
Results
Semiautomated measurements showed excellent agreement with MPR reference values for all TA measurements: high correlations (all r values >0.8) and minimal biases. All measurements were more reproducible than with MPR: higher intraclass correlation coefficients (0.94-0.96 vs 0.82-0.90) and lower coefficients of variation (5%-12% vs 8%-18%). Sex- and age-related differences were identified in 3D normal values of most TA parameters. Dynamic analysis showed that TA parameters vary throughout the cardiac cycle, reaching minimal values at end-systole and maximum values in late diastole.
Conclusions
Novel software for semiautomated analysis of TA geometry and dynamics provides accurate and reproducible measurements. Normal values of TA dimensions, parsed by sex and age, are reported.
背景：随着三尖瓣（TV）介入治疗的扩大，人们更加需要准确、可重复的三维经胸超声心动图（TTE）工具来评估三尖瓣环（TA）以及该结构的三维正常值。我们的目标是：开发用于三维经胸超声心动图（TTE）分析三尖瓣环（TA）的新型半自动化软件，将其准确性和可重复性与多平面重建（MPR）参考值进行比较，并确定正常值。方法：使用新型半自动化软件和传统的 MPR 方法（作为参考标准），分别由 3 名独立读者对 113 名不同程度三尖瓣反流患者的三维经胸超声心动图图像进行分析。对于每个测量参数，采用线性回归和布兰-阿尔特曼分析评估技术间的一致性，采用类内相关（ICC）和变异系数（CoV）评估阅读器间的变异性。此外，还使用这款新软件分析了 WASE 研究中 789 名受试者的 3DTTE 数据集，以确定 TA 各参数的正常值：半自动测量结果显示，所有 TA 测量值与 MPR 参考值非常一致：相关性高（所有 r 值均大于 0.8），偏差极小。所有测量结果的可重复性均优于 MPR：ICC 值更高（0.94-0.96 vs 0.82-0.90），CoV 更低（5-12% vs 8-18%）。在大多数 TA 参数的 3D 正常值中发现了与性别和年龄相关的差异。动态分析显示，TA参数在整个心动周期中都在变化，在舒张末期达到最小值，在舒张晚期达到最大值：结论：用于对 TA 几何形状和动态进行半自动分析的新型软件可提供准确、可重复的测量结果。本文报告了按性别和年龄划分的 TA 尺寸正常值。
期刊介绍：
The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.
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