Validation of a Holographic Display for Quantification of Mitral Annular Dynamics by Three-Dimensional Echocardiography

Karl-Andreas Dumont; John-Peder Escobar Kvitting; Jørn S Karlsen; Espen W Remme; John Hausken; Runar Lundblad; Arnt E Fiane; Stig Urheim

doi:10.1016/j.echo.2018.08.010

Validation of a Holographic Display for Quantification of Mitral Annular Dynamics by Three-Dimensional Echocardiography

J Am Soc Echocardiogr. 2019 Feb;32(2):303-316.e4. doi: 10.1016/j.echo.2018.08.010. Epub 2018 Oct 5.

Authors

Karl-Andreas Dumont¹, John-Peder Escobar Kvitting², Jørn S Karlsen³, Espen W Remme⁴, John Hausken⁵, Runar Lundblad², Arnt E Fiane⁶, Stig Urheim⁷

Affiliations

¹ Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. Electronic address: kardum@ous-hf.no.
² Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
³ Kalkulo AS, Fornebu, Norway.
⁴ Institute for Surgical Research, The Intervention Center, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁵ Department of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁶ Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁷ Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Bergen, Norway.

PMID: 30293779
DOI: 10.1016/j.echo.2018.08.010

Abstract

Background: Three-dimensional (3D) echocardiography with multiplanar reconstruction (MPR) is used clinically to quantify the mitral annulus. MPR images are, however, presented on a two-dimensional screen, calling into question their accuracy. An alternative to MPR is an autostereoscopic holographic display that enables in-depth visualization of 3D echocardiographic data without the need for special glasses. The aim of this study was to validate an autostereoscopic display using sonomicrometry as a gold standard.

Methods: In 11 anesthetized open-chest pigs, sonomicrometric crystals were placed along the mitral annulus and near the left ventricular apex. High-fidelity catheters measured left atrial and ventricular pressures. Adjustments of pre- and afterload were done by constriction of the inferior vena cava and the ascending aorta, respectively. Three-dimensional epicardial echocardiography was obtained from an apical view and converted to the autostereoscopic display. A 3D virtual semitransparent annular surface (VSAS) was generated to measure commissure width (CW), septal-lateral length, area of the mitral annular surface, nonplanarity angle, and the annular height-to-commissure width ratio in mid-systole and late diastole.

Results: Mitral annular measurements from the 3D VSAS derived from the 3D echocardiographic images and autostereoscopic display correlated well with sonomicrometry over a range of loading conditions: CW length (r = 0.98, P < .00001), septal-lateral length (r = 0.98, P < .00001), annular surface area (r = 0.93, P < .001), nonplanarity angle (r = 0.87, P < .001), and annular height-to-commissure width ratio (r = 0.85, P < .01). The 3D VSAS showed better agreement with the sonomicrometric measurements compared with MPR.

Conclusions: Mitral annular measurements using 3D VSAS correlate well with sonomicrometry over a range of loading conditions and may represent a powerful tool for noninvasive quantification of mitral annular dynamics.

Keywords: 3D echocardiography; Mitral valve; Mitral valve annulus; Sonomicrometry.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Atrial Function, Left / physiology*
Diastole
Echocardiography, Three-Dimensional / methods*
Echocardiography, Transesophageal / methods*
Female
Holography / methods*
Male
Mitral Valve / diagnostic imaging*
Models, Animal
Reproducibility of Results
Swine
Ventricular Function, Left / physiology*
Ventricular Pressure / physiology*