Descending aortic strain quantification by intra-operative transesophageal echocardiography: Multimodality validation via cardiovascular magnetic resonance
Descending aortic strain quantification by intra-operative transesophageal echocardiography: Multimodality validation via cardiovascular magnetic resonance
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DOI：
10.1111/echo.14851
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发表时间：
2020-09-10
影响因子：
1.5
通讯作者：
Weinsaft, Jonathan W.
中科院分区：
文献类型：
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作者：
Rong, Lisa Q.;Palumbo, Maria C.;Weinsaft, Jonathan W.
背景心脏磁共振（CMR）成像可提供主动脉扩张性（应变）的高时间分辨率成像，而经食管超声心动图（TEE）广泛用于术中主动脉成像，并为主动脉评估提供了一种临床替代方法。我们测试了在接受升主动脉瘤外科移植物修复术的患者中，在TEE上测量的术中整体周向主动脉应变（GCS）与CMR衍生应变参考值的关系。方法前瞻性对拟行主动脉修补术的患者进行CMR（3 T）检查。术中进行TEE;图像与MRI共定位。CMR和TEE上的GCS独立量化，对其他方式的结果不知情。结果研究了25例患者（54 ± 10岁，88%为男性），包括13例遗传介导的动脉瘤和12例退行性动脉瘤：CMR和TEE在12 ± 9天内进行。脉压（PP）校正的降主动脉TEE得出的GCS与电影CMR得出的GCS密切相关（r = 0.75，P = 0.002），尽管绝对GCS和PP校正值略低（分别为5.40 +/- 1.11 vs 6.49 +/- 1.43%和11.55 +/- 3.04 vs 13.99 +/-4.53%）。同样，TEE显示舒张末期面积略低（EDA [5.1 +/- 1.7 cm（2）vs 5.8 +/- 1.3 cm（2），P = .004]）和收缩末期面积（ESA [6.1 +/- 1.9 cm（2）vs 6.5 +/- 1.7 cm（2），P = 0.10]），两种模式之间存在显著相关性（r = 0.73，0.76，P均<0.05）。结论：本探索性研究支持TEE评估手术高危人群主动脉GCS的可行性，以及术中TEE与术前CMR之间的一致程度。我们发现，有一个显着的GCS和EDA和ESA主动脉面积之间的相关性，但TEE衍生的参数低估CMR值的一个小，但显着的量。
Background Whereas cardiac magnetic resonance (CMR) imaging provides high temporal resolution imaging of aortic distensibility (strain), transesophageal echocardiography (TEE) is widely used for intra-operative aortic imaging and provides a clinical alternative for aortic assessment. We tested intra-operative global circumferential aortic strain (GCS) measured on TEE in relation to the reference of CMR-derived strain among patients undergoing surgical graft repair of ascending aortic aneurysms. Methods CMR (3T) was prospectively performed in patients scheduled for aortic repair. TEE was performed intra-operatively; images were co-localized with MRI. GCS on CMR and TEE was quantified independently, blinded to results of the other modality. Results 25 patients (54 +/- 10 year-old, 88% male) were studied, inclusive of 13 genetically mediated and 12 degenerative aneurysms: CMR and TEE were performed within 12 +/- 9 days. Pulse pressure (PP)-adjusted descending aortic TEE-derived GCS strongly correlated with cine-CMR-derived GCS (r = .75,P = .002) though absolute GCS and PP-adjusted values were slightly lower (5.40 +/- 1.11 vs 6.49 +/- 1.43% and 11.55 +/- 3.04 vs 13.99 +/- 4.53%, respectively). Similarly, TEE yielded slightly lower end-diastolic area (EDA [5.1 +/- 1.7 cm(2)vs 5.8 +/- 1.3 cm(2),P = .004]) and end-systolic area (ESA [6.1 +/- 1.9 cm(2)vs 6.5 +/- 1.7 cm(2),P = .10]), with significant correlations between the two modalities (r = .73, .76,P < .05 for all). Conclusions This exploratory study supports feasibility of TEE for assessing aortic GCS in a surgical at-risk population, as well as magnitude of agreement between intra-operative TEE and preoperative CMR. We found that there is a significant correlation between GCS and EDA and ESA aortic areas, but that TEE-derived parameters underestimated CMR values by a small but significant amount.