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Published on: November 28, 2018
Indirect ultrasound evaluation of left ventricular outflow tract diameter implications for heart failure and aortic
Gabriele Pestelli1,2, Andrea Fiorencis3, Valeria Pergola4
1Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.
Insights
A new formula predicts left ventricular outflow tract diameter (LVOTD) using aortic root and LV dimensions, improving accuracy over body surface area (BSA) alone. This enhances assessments in heart failure (HF) and aortic stenosis (AS).
Area of Science:
- Cardiology
- Echocardiography
- Medical Imaging
Background:
- Left ventricular outflow tract diameter (LVOTD) dependency on body surface area (BSA) is established.
- The relationship between LVOTD and aortic root/left ventricular (LV) dimensions is unexplored.
- Accurate LVOTD assessment is crucial for heart failure (HF) and aortic stenosis (AS) evaluation.
Purpose of the Study:
- To explore the relationship between LVOTD and aortic root/LV dimensions.
- To develop a novel predictive equation for LVOTD incorporating these dimensions.
- To compare the novel equation with the existing BSA-derived formula.
Main Methods:
- A cohort of 540 HF patients underwent transthoracic echocardiography.
- Patients were divided into derivation (N=340) and validation (N=200) subgroups.
- A regression equation was derived using independent determinants of LVOTD and validated.
Main Results:
- Sinuses of Valsalva diameter (SVD), BSA, LV end-diastolic diameter (LVEDD), and height were independent LVOTD determinants.
- The novel regression equation (LVOTD = 6.209 + [0.201 × SVD] + [1.802 × BSA] + [0.03 × LVEDD] + [0.025 × Height]) showed high correlation with measured LVOTD (R=0.739).
- The novel equation performed significantly better than the BSA-derived formula.
Conclusions:
- Aortic root and LV dimensions independently influence LVOTD.
- A new comprehensive equation incorporating these dimensions improves LVOTD prediction.
- This advancement aids LV output evaluation in HF and AS severity assessment when direct measurement is challenging.
Background:
Whereas dependency of left ventricular outflow tract diameter (LVOTD) from body surface area (BSA) has been established and a BSA-based LVOTD formula has been derived, the relationship between LVOTD and aortic root and LV dimensions has never been explored. This may have implications for evaluation of LV output in heart failure (HF) and aortic stenosis (AS) severity.
Methods:
A cohort of 540 HF patients who underwent transthoracic echocardiography was divided in a derivation and validation subgroup. In the derivation subgroup (N = 340), independent determinants of LVOTD were analyzed to derive a regression equation, which was used for predicting LVOTD in the validation subgroup (N = 200) and compared with the BSA-derived formula.
Results:
LVOTD determinants in the derivation subgroup were sinuses of Valsalva diameter (SVD, beta = 0.392, P < .001), BSA (beta = 0.229, P < .001), LV end-diastolic diameter (LVEDD, beta = 0.145, P = .001), and height (beta = 0.125, P = .037). The regression equation for predicting LVOTD with the aforementioned variables (LVOTD = 6.209 + [0.201 × SVD] + [1.802 × BSA] + [0.03 × LVEDD] + [0.025 × Height]) did not differ from (P = .937) and was highly correlated with measured LVOTD (R = 0.739, P < .001) in the validation group. Repeated analysis with LV end-diastolic volume instead of LVEDD and/or accounting for gender showed similar results, whereas BSA-derived LVOTD values were different from measured LVOTD (P < .001).
Conclusion:
Aortic root and LV dimensions affect LVOTD independently from anthropometric data and are included in a new comprehensive equation for predicting LVOTD. This should improve evaluation of LV output in HF and severity of AS when direct LVOTD measurement is difficult or impossible.
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