Value of anatomical aortic valve area using real-time three-dimensional transoesophageal echocardiography in patients with aortic stenosis: A comparison between tricuspid and bicuspid aortic valves

Abstract

Aims: Accurate assessment of disease severity is critical for appropriate treatment of patients with aortic stenosis (AS). This study investigated the influence of aortic-valve morphology on the determination of anatomical aortic-valve area (AVA) in patients with AS. Methods and results: This prospective study included 126 patients with ASwhounderwent transoesophageal echocardiography (TEE). Aorticvalve areawas measured using (i) planimetric two-dimensional (2D) TEE, (ii) volumetric three-dimensional (3D) TEE, and (iii) the continuity equation (CE) obtained with transthoracic echocardiography. Of these, 20 patients also underwent contrast-enhanced multidetector computed tomography (MDCT). Aortic-valve areawas measured from multiplanar reconstruction of the MDCT images. Of the 126 patients, 20 (15.9%) were diagnosed with bicuspid AS and 106 were diagnosed with tricuspid AS. Therewas an excellent correlation between AVAADCT and AVA3DTEE (r = 0.83, P < 0.001) and a somewhat lower correlation between AVAADCT and AVA2DTEE (r = 0.63, P = 0.006). In the tricuspid AS group, both AVA2DTEE and AVA3DTEE significantly correlated with AVACE (r = 0.63, mean difference 0.13+0.24 cm2, and r = 0.83, mean difference 0.03±0.12 cm2, respectively, both P < 0.001). In contrast, in the bicuspid AS group, AVA3DTEE significantly correlated with AVACE (r = 0.83, mean difference 0.10±0.18 cm2, P < 0.001), whereas AVA2DTEE did not (r = 0.42, mean difference 0.48±0.32 cm2, P = 0.066). Conclusion: Aortic-valve morphology influenced the assessment of anatomical AVA in patients with AS, and 3DTEE is useful for assessing anatomical AVA regardless of aortic-valve morphology.