Normal reference values of three-dimensional speckle-tracking echocardiography-derived aortic valve annular dimensions in healthy adults

Introduction Three-dimensional speckle-tracking echocardiography (3DSTE) is a relatively new cardiovascular imaging technique which is mostly used for cardiac chamber quantifications including volumetric and strain assessments. However, its capability in ‘en-face’ assessment of valvular annuli has also been demonstrated. Considering the importance of the aortic valve and its pathologies, it has been found to be important to present the 3DSTE-derived normal reference values of dimensions of the aortic valve annulus (AVA) in a healthy adult population in different ages and genders. Methods The present study consisted of 251 healthy adult individuals, due to inferior image quality during 3DSTE, 101 cases were excluded (40%), hence the final number of cases proved to be 150 with the mean age of 34.8 ± 12.3 years (82 males). This population has been further divided according to their age: 18–29 years (n = 67; mean age: 24.6 ± 2.7 years, 35 males), 30–39 years (n = 40; mean age: 33.8 ± 2.8 years, 29 males), 40–49 years (n = 18; mean age: 43.1 ± 3. 8 years, 11 males) and 50+ years (n = 25, mean age: 57.3 ± 4.9 years, 7 males). Results Out of 150 subjects, end-systolic AVA area was larger than, equal to or lower than that of the end-diastolic counterpart in 89 (59%), 12 (9%) and 48 (32%) cases, respectively. End-systolic minimum AVA diameter, AVA area and AVA perimeter proved to be larger than their counterpart in end-diastole in group level. End-systolic AVA area was larger than end-diastolic AVA area in the same ratio in males and females aged 18-29 years (19 out of 32, 59% and 22 out of 35, 63%, respectively) and aged 50+ (10 out of 18, 56% and 4 out of 7, 57%, respectively). In subjects aged 30-39 years, end-systolic AVA area was larger than end-diastolic AVA area in tendentiously lower ratio in females than in males (4 out of 11, 36% and 18 out of 29, 63%, p=0.08, respectively). Similar relationship was found in individuals aged 40-49 years (3 out of 7, 43% and 9 out of 11, 82%, p=0.08, respectively). In group level, no differences could be detected between AVA parameters in age decades. Most parameters were significantly lower in females than in males except for subjects aged 50+ years. End-diastolic and end-systolic maximum AVA diameter and perimeter and end-systolic minimum AVA diameter and area were present between females aged 40-49 years and 50+ years. Females aged 50+ years had larger end-diastolic minimum AVA diameter as compared to that of females aged 18-29 years and 30-39 years. Females aged 18-29 years had larger end-systolic AVA perimeter as compared to that of females aged 40-49 years. Similar findings were not present in case of males. Conclusions Age and gender-dependency of 3DSTE-derived AVA dimensions could be demonstrated in healthy adults.