Abstract
Purpose: To assess reproducibility of Real time 3D echocardiography (RT3D) and ECG-gated 3D echocardiography (EG3D) when measuring the mitral valve area (MVA) in rheumatic mitral stenosis (MS). Methods: MVA was assessed by three operators in 68 MS patients using RT3D and EG3D. Reproducibility of each technique was determined by calculating the standard error of measurements (SEM). Results: SEM was similar between RT3D and EG3D. MVA variability was of 0.4 cm² or 30% of any RT3D or EG3D measured MVA. The minimal change in MVA above which two measurements should be considered to differ significantly for the same operator was of 0.4 cm² for RT3D and 0.5 cm² for EG3D. For two different operators making successive measurements, the minimum significant change was of 0.5 cm² for RT3D and 0.6 cm² for EG3D. The minimum significant difference when switching from RT3D to EG3D or vice versa is of 0.6 cm². Low temporal resolution of 6 Hz has the least variability when using RT3D (0.19 cm² vs. 0.26 cm², p = 0.009) but significantly underestimated MVA (1.3 ± 0.4 cm² vs. 1.4 ± 0.4 cm², p < 10− 3) when compared to EG3D. MVA variability was significantly higher in mild MS when compared to severe MS whether it is RT3D (0.23 cm² vs. 0.18 cm², p = 0.02) or EG3D (0.27 cm² vs. 0.16 cm², p < 0.001). Conclusion: RT3D and EG3D are equally reproducible in the assessment of MVA in patients with MS. Further measurements standardization is required to have a clinically acceptable estimations of the true 3D MVA and minimal detectable differences.
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data can be made available upon reasonable request to the corresponding author.
Abbreviations
- EGT3D:
-
ECG-gated 3D echocardiography
- ICC:
-
Intraclass correlation coefficient
- IPS:
-
Image per second
- MDD95% :
-
Minimal detectable difference with 95% confidence
- MS:
-
Mitral stenosis
- MVA:
-
Mitral valve area
- PTMC:
-
Percutaneous transvenous mitral commissurotomy
- RT3D:
-
Real time 3D echocardiography
- SC:
-
Surgical commissurotomy
- SEM:
-
Standard error of measurements
- TRVmax:
-
Tricuspid regurgitation maximum velocity
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Nidhal Bouchahda ], [Marwa Jarray] and [Yessine Kallela].The first draft of the manuscript was written by [Nidhal Bouchahda] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Bouchahda, N., Jarraya, M., Kallala, Y. et al. Reproducibility of transthoracic 3D echocardiography in the assessment of mitral valve area in patients with rheumatic mitral stenosis: real time versus ECG-gated 3D echocardiography. Int J Cardiovasc Imaging 39, 2419–2426 (2023). https://doi.org/10.1007/s10554-023-02939-2
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DOI: https://doi.org/10.1007/s10554-023-02939-2