Transoesophageal echocardiography was superior to transthoracic echocardiography for evaluating bicuspid aortic valve phenotype (sensitivity 92% vs 77%, specificity 94% vs 82%).
Cross-Sectional (n=169)
Do TEE and TTE accurately assess aortic valve phenotype and degree of calcification compared to intra-operative evaluation in patients undergoing aortic valve surgery?
TEE is superior to TTE for evaluating aortic valve phenotype (bicuspid vs tricuspid), while both modalities correlate well with intra-operative assessment for aortic valve calcification using real-time images.
INTRODUCTION: Aortic valve calcification (AVC) may predict poor outcome. Bicuspid aortic valve (BAV) leads to several haemodynamic changes accelerating the progress of aortic valve (AV) disease. AIMS: To compare the diagnostic accuracy of transoesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in the assessment of aortic valve phenotype and degree of AVC, with intra-operative evaluation as a reference. METHODS: We examined 169 patients (median age 65 years, 51 women) without significant coronary artery disease undergoing AV and/or aortic root surgery. TTE was performed within a week prior to surgery and TEE at the time of surgery. RESULTS: Compared with surgical AVC assessment, visual evaluation using a 5-grade scoring system and real-time images showed a higher correlation (TTE r = 0·83 and TEE r = 0·82) than visual (TTE r = 0·64 and TEE 0·63) or grey scale mean (GSMn) (TTE r = 0·63 and TEE r = 0·52) assessment of end-diastolic still frames. AVC assessment using real-time images showed high intraclass correlation coefficients (TTE 0·94 and TEE 0·93). With regard to BAV, TEE was superior to TTE with a higher interobserver agreement, sensitivity and specificity (0·86, 92% and 94% versus 0·57, 77% and 82%, respectively). CONCLUSION: Semi-quantitative AVC assessment of real-time cine loops from both TEE and TTE correlated well with intra-operative evaluation of AVC. Applying a predefined scoring system for AVC evaluation assures a high interobserver correlation. TEE was superior to TTE for evaluation of valve phenotype and should be considered when a diagnosis of BAV is clinically important.
Yousry et al. (Thu,) conducted a cross-sectional in Aortic valve disease (n=169). Transoesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) vs. Intra-operative evaluation was evaluated on Diagnostic accuracy in the assessment of aortic valve phenotype and degree of aortic valve calcification. Transoesophageal echocardiography was superior to transthoracic echocardiography for evaluating bicuspid aortic valve phenotype (sensitivity 92% vs 77%, specificity 94% vs 82%).