Cardiology Resident Colorado State University Fort Collins, Colorado, United States
Abstract: Background – Comparability of geometric orifice area by computed tomography (GOA_CT) to echocardiographic indices of pulmonary valve stenosis (PS) severity is unknown. Hypothesis/Objectives – To evaluate the correlation and agreement between transthoracic (TTE) and transesophageal echocardiographic (TEE) indices of PS to GOA_CT. Animals – 16-dogs with PS Methods – Observational cross-sectional study. Dogs underwent TTE and CCT on the same day and TEE within 1-week. Measurements were performed by the same investigator. Correlation (Pearson) and agreement (Bland-Altman) between TTE PS severity indices, GOA_TEE, and GOA_CT were investigated. Measurement variability was evaluated by coefficients of variation (CV) in 6 randomly selected dogs measured 3 times by the same investigator and independently measured by 3 different investigators. Results – Correlations between TTE effective orifice area (EOA_TTE) (r = 0.669, P = 0.005), maximum pressure gradient (maxPG) by TTE (r = -0.502, P = 0.048), 2D_GOA_TEE (r = 0.657, P = 0.008), 3D_GOA_TEE (r = 0.725, P = 0.003) and GOA_CT were identified. Velocity ratio, velocity time integral ratio, and maxPG_TEE failed to correlate with GOA_CT (P ≥ 0.07). Bias and limits of agreement showed EOA_TTE (0.31 [-0.04, 0.58] cm2/m2), 2D_GOA_TEE (0.29 [-0.09, 0.66] cm2/m2), and 3D_GOA_TEE (0.29 [-0.05, 0.64] cm2/m2) were variable and consistently smaller than GOA_CT. Coefficients of variation for GOA_CT, 2D_GOA_TEE, and 3D_GOA_TEE were 10.8 - 17.4%, 17.8 - 26.4, and 10.7 - 32.5%, respectively. Conclusions – As expected, EOA_TTE underestimates GOA_CT but measurements were shown to be correlated. Measurements of GOA by TEE and CCT are not interchangeable.
