Determinants of effective height in morphologically normal tricuspid aortic valves: A computed tomography-based anatomical study.

Avaliação da Velocidade da Onda de Pulso por Meio de Ecocardiografia Transtorácica em Crianças com Válvula Aórtica Bicúspide

Resumo Fundamento O aumento da rigidez aórtica em pacientes com válvula aórtica bicúspide (VAB) pode afetar significativamente a morbidade e a mortalidade. Objetivo Nosso objetivo foi avaliar as propriedades de elasticidade da aorta e a usabilidade da nova técnica, medindo a velocidade da onda de pulso (VOP) com um dispositivo de ecocardiografia transtorácica em pacientes com VAB. Métodos Cinquenta pacientes com VAB e 50 crianças saudáveis com características demográficas semelhantes foram incluídos neste estudo. Os pacientes com VAB foram agrupados de acordo com a morfologia das cúspides fundidas. A função valvar era normal ou quase normal nos pacientes com VAB incluídos no estudo. A função ventricular esquerda, o diâmetro da raiz da aorta e as características de elasticidade da aorta de todos os pacientes foram avaliadas. Um valor p <0,05 foi considerado significativo. Resultados A VOP foi significativamente maior no grupo com VAB (p=0,000). Os parâmetros de elasticidade aórtica obtidos a partir dos diâmetros da aorta ascendente foram semelhantes entre os grupos. Os diâmetros da aorta ascendente foram significativamente maiores no grupo com VAB. Houve correlação entre a VOP, o diâmetro da aorta ascendente, a vena contracta na regurgitação aórtica e a velocidade de pico aórtica. Os valores alfa de confiabilidade interobservador e intraobservador da VOP foram de 0,92 e 0,84, respectivamente. Conclusões No grupo pediátrico com VAB e função valvar normal ou quase normal, embora os parâmetros de elasticidade aórtica fossem normais com as medidas convencionais baseadas nos diâmetros da aorta ascendente, as medidas de VOP com o mesmo dispositivo foram significativamente maiores, sem a necessidade de um aparelho ou programa adicional, e a rigidez aórtica aumentou no grupo com VAB. A medição da VOP por ecocardiografia é uma técnica confiável e reprodutível.

Journal of Community Hospital Internal Medicine Perspectives Journal of Community Hospital Internal Medicine Perspectives

Vendor-independent Aortic Valve Calcium Scoring in Patients with Discordant Echocardiographic Criteria of Severe Aortic Stenosis.

Purpose To apply a vendor-neutral Agatston score (vnAS) for aortic valve calcification across multiple CT systems and to aortic stenosis severity classification. Materials and Methods Anthropomorphic phantoms with varying degrees of calcification were scanned using seven different CT systems and a reference electron-beam CT system to determine the vnAS. The vnAS was calculated using a regression model, whose performance was evaluated by both the coefficient of determination and analysis of variance. The vnAS was subsequently validated on a retrospective patient sample from eight international centers. Thresholds of severe aortic valve stenosis were defined as 1274 and 2065 AU for women and men, respectively. Results The Agatston scores from all CT systems were strongly correlated with that of the reference system (R2 > 0.932). On the basis of their echocardiographic findings, 183 of 831 (22.0%) patients (mean age ± SD, 77 years ± 10; 351 of 831 [42.2%] women) had discordant echocardiographic aortic valve stenosis findings. Among women with discordant results, the vnAS was higher than the traditional aortic valve calcium score (median, 1693 AU [IQR, 908-2513 AU] vs 1181 AU [IQR, 726-1964 AU], respectively; P < .001). Similar findings were observed for men (median, 2658 AU [IQR, 1894-3822 AU] vs 2056 AU [IQR, 1408-3056 AU], respectively; P < .001). Using the vnAS, 8.5% of women and 17.8% of men with discordant echocardiographic findings were reclassified into the severe aortic stenosis group. Conclusion A previously developed calibration tool, the vnAS, was validated and reclassified patients with discordant echocardiographic findings into the severe aortic stenosis group. Keywords: CT, Echocardiography, Percutaneous, Cardiac, Valves, Calcifications/Calculi, Technology Assessment, Vendor-neutral Agatston Score, Aortic Stenosis, Aortic Valve Calcification, Phantoms Supplemental material is available for this article. © RSNA, 2026 See also commentary by Jaltotage and Leipsic in this issue.

Optimal Reclassification of Aortic Aneurysms: Cross-Sectional CT vs 2D Transthoracic Echocardiography.

BACKGROUND Ascending aortopathy (AA) is largely asymptomatic but carries risk for death, dissection, or rupture. Typical guidelines approach of recommending surgery based on aortic diameters is limited, as most dissections occur at AA diameters <5 cm. OBJECTIVES The authors compared transthoracic echocardiography (TTE) and gated contrast-enhanced (CE)-computed tomographic angiography (CTA) for AA assessment and evaluated the prognostic utility of indexed parameters (aortic diameter height index [AHI] and cross-sectional area to height ratio [CSAH]). METHODS In 7,459 patients with AA (≥4 cm) undergoing both TTE and CTA, the authors assessed the concordance of aortic measurements and the prognostic value of absolute and indexed metrics for adverse outcomes (mortality, dissection, or rupture). RESULTS Compared with CE-CTA, TTE underestimated aortic size (particularly for aneurysms ≥5 cm) in 58% of aortic roots and 37% of mid-ascending aortas. At 3.6 ± 3.6 years, there were 865 (11.6%) composite events (708 [9.5%] deaths, 173 aortic dissections [2.3%], and 12 ruptures [0.2%]). Addition of individual AA cutoffs provided incremental prognostic value for the composite endpoint (all P < 0.001) as follows: 1) aortic diameter ≥5 cm (HR: 2.42; 95% CI: 1.77-2.99); 2) AHI >3.20 cm/m (HR: 3.24; 95% CI: 2.22-4.17); and 3) CSAH ≥10 cm2/m (HR: 2.09; 95% CI: 1.55-2.39). In 5,213 unoperated patients, 63% and 86% events occurred at diameters <5 cm and AHI ≤3.21 cm/m, respectively, whereas CSAH ≥10 cm2/m was associated with 53% events. CONCLUSIONS Indexed parameters, particularly CSAH, improve risk stratification beyond absolute diameters and highlight size-based differences in AA. CE-CTA-derived indices provide an individualized precision imaging-based approach to surgical decision-making.

Advanced 3D echocardiographic assessment of the aortic valve and aortic root complex: a repair-oriented perspective

Abstract Aims The aortic valve (AV) and aortic root complex constitute a functional unit, and their integrated anatomical and dynamic assessment is essential for the management of AV disease. This review highlights the role of three-dimensional echocardiography (3DE) in the comprehensive evaluation of AV disease and its contribution to therapeutic decision-making. Methods and results Owing to close collaboration with cardiac surgeons, 3DE has significantly expanded the diagnostic information provided by imaging cardiologists and has become a key tool for guiding therapeutic strategies. In patients with significant aortic regurgitation (AR), detailed anatomical assessment of the cusps enables characterization of valve morphology and tissue quality, while multiplanar reconstruction provides accurate measurements of the virtual basal ring, coronary ostial height, and other key anatomical structures. Quantitative assessment of cusp geometry, including effective, geometric, and coaptation heights, allows precise identification of AR mechanisms, thereby facilitating repair-oriented surgical planning. In aortic stenosis (AS), 3DE improves evaluation of discordant or borderline cases through enhanced assessment of the left ventricular outflow tract and direct planimetric measurement of AV area. In addition, 3DE provides complementary information for procedural planning of both transcatheter and surgical AV replacement, particularly in patients with contraindications to computed tomography. Conclusion Three-dimensional echocardiography, particularly transoesophageal 3DE, has become an essential imaging modality for integrating anatomical and functional information. It improves diagnostic accuracy, supports individualized therapeutic planning, and plays a pivotal role in promoting a repair-oriented approach to the management of aortic valve disease.

Left Ventricular Longitudinal Strain Is Associated with Ascending Aortic Diameters in Healthy Adults—A Detailed Single-Center Retrospective Analysis from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study

Background and Objectives: A more precise understanding of ventriculo–arterial coupling is essential, particularly regarding quantitative and qualitative associations can be demonstrated between the aorta and the left ventricle (LV), which is considered the engine of the central circulation. The aim of the present study was to investigate the associations between three-dimensional speckle-tracking echocardiography (3DSTE) derived unidimensional LV strains and end-systolic and end-diastolic ascending aortic diameters measured by M-mode echocardiography (MME). Additionally, the outcomes were analyzed after stratifying the parameters into below-average, average, and above-average. Materials and Methods: The present retrospective cohort study consisted of 162 healthy adult volunteers enrolled between 2011 and 2017, of which 93 participants (mean age: 30.6 ± 10.0 years; 54 males) were eligible for simultaneous 3DSTE-derived LV strain assessment and MME-based aortic dimension measurement. In all individuals, MME, two-dimensional Doppler echocardiography and 3DSTE were performed. Results: An increase in end-diastolic ascending aortic diameter (AAD) was associated with an increase in end-systolic AAD, and vice versa. At the maximum end-diastolic AAD, the basal, global, and mean segmental LV longitudinal strain (LS) values reached their lowest. When end-systolic AAD reached its maximum, both global and mean segmental LV-LS dropped to their minimum. The highest end-diastolic and end-systolic AADs were detectable in the presence of the lowest global LV-LS. With larger end-diastolic and end-systolic AADs, a trend toward higher LV radial strain was present. Conclusions: Even in the absence of cardiovascular pathology, a finely tuned interaction can be observed between regional LV deformation, especially with LV-LS and the size of the ascending aorta in healthy individuals.