| (Part 1)Quantitative evaluation of aortic regurgitation by general imaging three-dimensional quantification:a comparison with cardiac magnetic resonance ml yielded 93.3%sensitivity and 93.3%specificity in identifying severe AR(area under the curve=0.89,P<0.0001).(4)The intraobserver and interobserver reproducibility of the ARVol derived from GI3DQ method were good(ICC=0.94 and 0.93,respectively).Objectives:To investigate the feasibility and accuracy of general imaging three-dimensional quantification(GI3DQ)in the quantitative evaluation of aortic regurgitation(AR)severity and discuss the diagnostic value of the GI3DQ-derived aortic regurgitant volume(ARVol)in identifying severe AR.Methods:A total of 55 patients who were diagnosed with AR by twodimensional transthoracic echocardiography in our Ultrasonography Department from November 2020 to September 2021 were included and divided into central(n=27)and eccentric(n=28)AR groups according to the direction of the AR jet.All patients underwent routine two-dimensional and three-dimensional transthoracic echocardiography and cardiac magnetic resonance(CMR)examinations.The volume of maximum AR jet which is not mixed with mitral froward flow was measured by GI3DQ as ARVol.Taking the ARVol measured by CMR direct method as the reference standard,the accuracy of the ARVol measured by GI3DQ method was evaluated.And using the grading results according to the ARVol measured by CMR as the reference standard,the diagnostic value of the ARVol measured by GI3DQ in identifying severe AR was evaluated.Results:(1)For the entire population,the GI3DQ method demonstrated a good correlation and agreement with CMR in ARVol measurement(r=0.88,P<0.0001;mean difference=-1.0ml,P>0.05).The kappa agreement between GI3DQ and CMR in grading AR severity was good(k=0.85).(2)In central and eccentric AR groups,GI3DQ method also had good correlations(central,r=0.84;eccentric,r=0.84;both P<0.0001)and agreements(central,mean difference=-0.7ml;eccentric,mean difference=-1.4ml;both P>0.05)with CMR in ARVol measurement.The kappa agreements between GI3DQ and CMR in grading AR severity in both groups were good(central,k=0.81;eccentric,k=0.79).(3)As assessed by receiver operating characteristic curve analysis,the ARVol derived from GI3DQ method at a cutoff value of 59.9Conclusions:1.Measuring the maximum AR jet volume which is not mixed with mitral froward flow by GI3DQ method to replace the ARVol is feasible and reproducible in this study population.2.Taking CMR as the reference method,GI3DQ method can make relatively accurate measurement of the ARVol and correct grade of AR severity no matter what is the direction of the AR jet.3.The ARVol derived from the GI3DQ method can identify severe AR with good sensitivity and specificity.(Part 2)Quantitative evaluation of aortic regurgitation by realtime three-dimensional echocardiography planimetry method:a comparison with cardiac magnetic resonanceObjectives:To investigate the feasibility and accuracy of real-time three-dimensional echocardiography(RT3DE)planimetry method in the quantitative evaluation of aortic regurgitation(AR)severity and discuss the diagnostic value of the aortic regurgitant volume(ARVol)derived from RT3DE planimetry method in identifying severe AR.Methods:A total of 51 patients who were diagnosed with AR by twodimensional transthoracic echocardiography in our Ultrasonography Department from November 2020 to September 2021 were included and divided into central(n=24)and eccentric(n=27)AR groups according to the direction of the AR jet as well as mild AR group(n=11)and more than mild AR group(n=40)according the grading results based on the ARVol measured by cardiac magnetic resonance(CMR).All patients underwent routine two-dimensional and three-dimensional transthoracic echocardiography and CMR examinations.The effective regurgitant orifice area was measured by the proximal isovelocity surface area(PISA)method and RT3DE planimetry method respectively,and then multiplied by the AR velocity time integral to obtain ARVol.Taking the ARVol measured by CMR direct method as the reference standard,the accuracy of the ARVol derived from the PISA and RT3DE planimetry method was evaluated-And using the grading results based on the ARVol measured by CMR as the reference standard,the diagnostic value of the ARVol derived from RT3DE planimetry method in identifying severe AR was evaluated.Results:(1)For the entire population,the PISA and RT3DE planimetry method correlated well with CMR in ARVol measurement(r=0.85 and 0.89,respectively;both P<0.0001).Compared with CMR,PISA method made a mild overestimation(mean difference=0.3ml,P>0.05),while RT3DE planimetry method made a significant overestimation(mean difference=5.2ml,P<0.05)in ARVol measurement based on consistency analysis.But the 95%limits of agreement between the RT3DE planimetry method and CMR was smaller than that between the PISA method and CMR.The kappa agreements between PISA method and CMR,and between RT3DE planimetry method and CMR in AR severity grading were good(k=0.76 and 0.82,respectively).(2)In central AR group,the PISA and RT3DE planimetry method correlated well with CMR in ARVol measurement(r=0.65 and 0.67,respectively;both P<0.001).Compared with CMR,PISA method made a mild overestimation(mean difference=3.5ml,P>0.05),while RT3DE planimetry method made a significant overestimation(mean difference=6.9ml,P<0.05)in ARVol measurement based on consistency analysis.The 95%limits of agreement between the RT3DE planimetry method and CMR was also smaller than that between the PISA method and CMR.The kappa agreements between PISA method and CMR,and between RT3DE planimetry and CMR in AR severity grading were good(k=0.70 and 0.74,respectively).(3)In eccentric AR group,the PISA and RT3DE planimetry method also correlated well with CMR in ARVol measurement(both r=0.84;both P<0.0001).Compared with CMR,PISA method made a mild underestimation(mean difference=-2.7ml,P>0.05),while RT3DE planimetry method made a mild overestimation(mean difference=3.8ml,P>0.05)in ARVol measurement based on consistency analysis.The kappa agreement between RT3DE planimetry method and CMR in AR severity grading was good(k=0.77),while that between PISA method and CMR was inferior(k=0.68).(4)In mild AR group,RT3DE planimetry method made a significant overestimation(mean difference=15.7ml,P<0.05)compared with CMR in ARVol measurement based on consistency analysis.The grading consistency between these two methods was 45.5%.In more than mild AR group,RT3DE planimetry method only made a mild overestimation(mean difference=2.3ml,P>0.05)compared with CMR in ARVol measurement based on consistency analysis.The kappa agreement between these two methods was good(k=0.86).(5)As assessed by receiver operating characteristic curve analysis,the ARVol derived from RT3DE planimetry method at a cutoff value of 58.7ml yielded 100.0%sensitivity and 86.7%specificity in identifying severe AR(area under the curve=0.93,P<0.0001).(6)The intraobserver and interobserver reproducibility of the ARVol derived from RT3DE planimetry method were good(ICC=0.89 and 0.87,respectively).Conclusions:1.ARVol measurement using RT3DE planimetry method is feasible and reproducible in this study population.2.Taking CMR as the reference method,in mild AR group,RT3DE planimetry method make a significant overestimation of ARVol,while in more than mild AR group,RT3DE planimetry method can make relatively accurate measurement of the ARVol and correct grade of AR severity.The ARVol derived from the RT3DE planimetry method can identify severe AR with good sensitivity and specificity.3.The accuracy of RT3DE planimetry method in the grading of AR severity is better than that of conventional two-dimensional PISA method.(Part 3)Evaluation of aortic regurgitation by Dynamic HeartModel plus 3D Auto RV:a comparison with cardiac magnetic resonanceObjectives:To investigate the feasibility and accuracy of Dynamic HeartModel(DHM)plus 3D Auto RV method in the measurement of left and right ventricular volumes,function and aortic regurgitant volume(ARVol)for patients with aortic regurgitation(AR),and discuss the diagnostic value of the ARVol derived from DHM plus 3D Auto RV method in identifying severe AR.Methods:A total of 42 patients who were initially diagnosed with more than mild isolated AR by two-dimensional transthoracic echocardiography in our Ultrasonography Department from November 2020 to September 2021 were included.All patients underwent routine two-dimensional,threedimensional transthoracic echocardiography and cardiac magnetic resonance(CMR)examinations.Left ventricular(LV)end-diastolic volume(EDV),end-systolic volume(ESV),stroke volume(SV)and ejection fraction(EF)were measured by biplane Simpson’s method and DHM respectively.Right ventricular(RV)EDV,ESV,SV and EF were measured by 3D Auto RV.The difference between the LVSV and RVSV measured by DHM and 3D Auto RV was calculated as ARVol.Taking CMR as the reference method,the accuracy of DHM and 3D Auto RV measurement results was analyzed.And using the grading results according to the ARVol measured by CMR direct method as the reference standard,the diagnostic value of the ARVol measured by DHM plus 3D Auto RV method in identifying severe AR was evaluated.Results:(1)LV volumes and function:There were good correlations between the LVEDV,LVESV,LVSV and LVEF measured by biplane Simpson’s method and CMR respectively(r=0.83,0.82,0.80 and 0.75,respectively;all P<0.0001).Consistency analysis showed that the Biplane Simpson’s method made significant underestimations of LVEDV,LVESV and LVSV(all P<0.0001)and a significant overestimation of LVEF(P<0.0001)compared with CMR.There were also good correlations between the LVEDV,LVESV,LVSV and LVEF measured by DHM and CMR respectively(r=0.87,0.81,0.83 and 0.73,respectively;all P<0.0001),Consistency analysis showed that DHM also made underestimations of LVEDV,LVESV and LVSV(all P<0.0001)and a overestimation of LVEF(P<0.0001)compared with CMR.But the mean difference between DHM and CMR was smaller than that between biplane Simpson’s method and CMR.(2)RV volumes and function:There were good correlations between the RVEDV,RVESV,RVSV and RVEF measured by 3D Auto RV and CMR respectively(r=0.82,0.79,0.81 and 0.74,respectively;all P<0.0001).Consistency analysis showed that 3D Auto RV made underestimations of RVEDV,RVESV and RVSV(all P<0.05)and a overestimation of RVEF(P<0.05)compared with CMR.(3)DHM plus 3D Auto RV method correlated well with CMR in ARVol measurement(r=0.89,P<0.0001),with no significant difference based on consistency analysis(mean difference=0.8ml,P>0.05).The kappa agreement between DHM plus 3D Auto RV method and CMR in grading CAR severity was good(k=0.81).(4)As assessed by receiver operating characteristic analysis,ARVol measured by DHM plus 3D Auto RV method at a cutoff value of 62.1ml yielded 100.0%of sensitivity and 93.3%of specificity in identifying severe AR(area under the curve=0.95,P<0.0001).(5)The intraobserver and interobserver reproducibility of the LVEDV,LVESV,LVSV,LVEF,RVEDV,RVESV,RVSV,RVEF and ARVol measured by DHM plus 3D Auto RV method were all good(all ICC≥0.89).Conclusions:1.Left and right ventricular volumes,EF and ARVol measurement using DHM plus 3D Auto RV method is feasible and reproducible in this study population.2.Taking CMR as the reference method,DHM and 3D Auto RV can make relatively accurate measurement of left and right ventricular volumes and EF,but still with underestimations of left and right ventricular volumes and overestimations of left and right ventricular EF to some extent.However,the accuracy of the measurement results by DHM is better than that by conventional biplane Simpson’s method.3.Taking CMR as the reference method,DHM plus 3D Auto RV method can make relatively accurate measurement of the ARVol and correct grade of AR severity.The ARVol measured by DHM plus 3D Auto RV method can identify severe AR with good sensitivity and specificity. |
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