loading page

Level of agreement between three-dimensional transthoracic and transesophageal echocardiography for mitral annulus evaluation: a feasibility and comparison study
  • +3
  • Ignatios Ikonomidis,
  • Özge Özden Tok,
  • Apostolos Tzikas,
  • Chourmouzios A. Arampatzis,
  • Manni Vannan A
Iatriko Diavalkaniko Kentro

Corresponding Author:[email protected]

Author Profile
Ignatios Ikonomidis
Panepistemiako Geniko Nosokomeio Attikon - B Kardiologike Klinike
Author Profile
Özge Özden Tok
Istanbul Universitesi Kardiyoloji Anabilim Dali
Author Profile
Apostolos Tzikas
Iatriko Diavalkaniko Kentro
Author Profile
Chourmouzios A. Arampatzis
Iatriko Diavalkaniko Kentro
Author Profile
Manni Vannan A
Piedmont Heart Institute
Author Profile


Introduction: Mitral annulus (MA) assessment is of utmost importance for the management of patients with mitral valve (MV) abnormalities and Three-dimensional transesophageal echocardiography (3D-TOE) has been the only reliable echocardiographic method for the evaluation of the mitral annulus by now. However, newer transthoracic echocardiography (TTE) probes have enabled to provide accurate measurements when TOE is contraindicated. The aim of this study is to assess the feasibility of 3D-TTE analysis of MA and the level of agreement with 3D-TOE measurements. Methods: A total of 121 consecutive patients were assessed with 3D-TTE and TOE. All MA parameters were retrospectively analyzed with the dedicated 4D-autoMVQ application. Bland-Altman analysis and intraclass correlation coefficient were used for the comparison and agreement between the two methods. Half of our patients had normal mitral valves and served as control group, while the other half had various mitral valve pathologies. Results: AutoMVQ analysis was not feasible in 11 out of 121 TTE examinations (91% feasibility) and in 4 out of 121 TOE examinations (96% feasibility). MA area and perimeter were slightly larger in TTE than those measured by TOE (12.7±3.6 vs 12.4±3.2cm2 for area and 12.7±1.7 vs 12.5±1.6cm for perimeter), however still showing strong correlation (r=0.942 and r=0.922 respectively). The majority of MV measurements were similar between the two methods with strong correlation (r>0.80). Conclusions: Assessment of the MV with 3D TTE with dedicated MVQ software is feasible and accurate, showing strong correlation and agreement with TOE measurements.
13 Jun 2022Submitted to Echocardiography
14 Jun 2022Submission Checks Completed
14 Jun 2022Assigned to Editor
03 Jul 2022Reviewer(s) Assigned
24 Jul 2022Review(s) Completed, Editorial Evaluation Pending
09 Aug 2022Editorial Decision: Revise Minor
08 Sep 20221st Revision Received
19 Sep 2022Submission Checks Completed
19 Sep 2022Assigned to Editor
19 Sep 2022Reviewer(s) Assigned
29 Sep 2022Review(s) Completed, Editorial Evaluation Pending
11 Oct 2022Editorial Decision: Accept