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Geometry of the left ventricular outflow tract assessed by 3D TEE in patients with aortic stenosis: impact of upper septal hypertrophy on measurements of Doppler-derived left ventricular stroke volume

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Abstract

Background

It is unclear how upper septal hypertrophy (USH) affects Doppler-derived left ventricular stroke volume (SV) in patients with AS. The aims of this study were to: (1) validate the accuracy of 3D transesophageal echocardiography (TEE) measurements of the left ventricular outflow tract (LVOT), (2) evaluate the differences in LVOT geometry between AS patients with and without USH, and (3) assess the impact of USH on measurement of SV.

Methods

In protocol 1, both 3D TEE and multi-detector computed tomography were performed in 20 patients with AS [aortic valve area (AVA) ≤ 1.5 cm2]. Multiplanar reconstruction was used to measure the LVOT short and long diameters in four parts from the tip of the septum to the annulus. In protocol 2, the same 3D TEE measurements were performed in AS patients (AVA ≤ 1.5 cm2, n = 129) and controls (n = 30). We also performed 2D and 3D transthoracic echocardiography in all patients.

Results

In protocol 1, excellent correlations of LVOT parameters were found between the two modalities. In protocol 2, the USH group had smaller LVOT short and long diameters than the non-USH group. Although no differences in mean pressure gradient, or SV calculated with the 3D method existed between the two groups, the USH group had greater SV calculated with the Doppler method (73 ± 15 vs. 66 ± 15 ml) and aortic valve area (0.89 ± 0.26 vs. 0.73 ± 0.24 cm2) than the non-USH group.

Conclusions

3D TEE can provide a precise assessment of the LVOT in AS. USH affects the LVOT geometry in patients with AS, which might lead to inaccurate assessments of disease severity.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan

    Dan Koto, Masaki Izumo, Kengo Suzuki, Kihei Yoneyama, Tomomi Suzuki, Ryo Kamijima, Tomoo Harada & Yoshihiro J. Akashi

  2. Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan

    Takafumi Machida

  3. Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan

    Yasuyuki Kobayashi

Authors
  1. Dan Koto
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  2. Masaki Izumo
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  3. Takafumi Machida
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  4. Kengo Suzuki
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  5. Kihei Yoneyama
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  6. Tomomi Suzuki
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  8. Yasuyuki Kobayashi
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  9. Tomoo Harada
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  10. Yoshihiro J. Akashi
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Corresponding author

Correspondence to Masaki Izumo.

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Conflict of interest

Dan Koto, Masaki Izumo, Takafumi Machida, Kihei Yoneyama, Tomomi Suzuki, Ryo Kamijima, Yasuyuki Kobayashi, Tomoo Harada, and Yoshihiro J. Akashi declare that they have no conflicts of interest.

Human rights statements and informed consent

All procedure followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. The participants were well-informed prior to the test; written informed consent was obtained before enrollment.

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Koto, D., Izumo, M., Machida, T. et al. Geometry of the left ventricular outflow tract assessed by 3D TEE in patients with aortic stenosis: impact of upper septal hypertrophy on measurements of Doppler-derived left ventricular stroke volume. J Echocardiogr 16, 162–172 (2018). https://doi.org/10.1007/s12574-018-0383-7

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  • DOI: https://doi.org/10.1007/s12574-018-0383-7

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