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European Journal of Echocardiography Advance Access published online on October 4, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep154
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Real-time three-dimensional transoesophageal echocardiography in the assessment of aortic valve stenosis

Gonzalo de la Morena*, Daniel Saura, María J. Oliva, Federico Soria, Josefa González, Miguel García, Victoria Moreno, Juan C. Bonaque and Mariano Valdés

Laboratorio de Ecocardiografía, Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Ctra. Murcia-Cartagena S/N, 30120 Murcia, Spain

Received 3 May 2009; accepted after revision 10 September 2009.

* Corresponding author. Tel: +34 968369484. fax: +34 968369662; E-mail address: gdlmorena{at}yahoo.es


  Abstract

Aims: To determine the feasibility of real-time three-dimensional transoesophageal echocardiography (3D-TOE) in the evaluation of aortic valve stenosis, to study its reliability, and to test the concordance of this new method when compared with transthoracic two-dimensional echocardiography (2D-TTE) as the diagnostic standard.

Methods and results: Fifty-nine consecutive patients with moderate-to-severe aortic valve stenosis were assessed by means of 2D-TTE and 3D-TOE by independent blinded observers. Aortic valve planimetry was possible in 94.9% of patients. Inter-observer intraclass correlation coefficients (ICC) were 0.892 (CI 95% 0.818–0.936; P < 0.001), and 0.871 (CI 95% 0.780–0.925; P < 0.001) for 2D-TTE and 3D-TOE, respectively. Bland-Altman plot showed a mean difference in aortic valve area (AVA) of 0.040 cm2, with 2D-TTE yielding larger values than 3D-TOE. ICC of both methods was 0.724 (CI 95% 0.530–0.839; P < 0.001).

Conclusion: Assessment of AVA by means of 3D-TOE is feasible in most patients with aortic valve stenosis. Reliability of the measurement is good. However, there is some disagreement with standard 2D-TTE that needs further investigation.

Keywords: Aortic valve stenosis; Diagnostic imaging; Ultrasonography; Validation studies; Reproducibility of results


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