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INDIRECT ULTRASOUND EVALUATION OF LEFT VENTRICULAR OUTFLOW TRACT DIAMETER IMPLICATIONS FOR HEART FAILURE AND AORTIC STENOSIS SEVERITY ASSESSMENT.
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  • Gabriele Pestelli,
  • Andrea Fiorencis,
  • Valeria Pergola,
  • Giovanni Luisi,
  • Vittorio Smarrazzo,
  • Filippo Trevisan,
  • Donato Mele
Gabriele Pestelli
Morgagni-Pierantoni Hospital
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Andrea Fiorencis
Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna
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Valeria Pergola
Università degli Studi di Padova Dipartimento di Scienze Cardiologiche Toraciche e Vascolari
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Giovanni Luisi
Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna
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Vittorio Smarrazzo
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Filippo Trevisan
Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna
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Donato Mele
University of Ferrara
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Abstract

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<0.001), BSA (beta=0.229, P<0.001), LV end-diastolic diameter (LVEDD, beta=0.145, P=0.001), and height (beta=0.125, P=0.037). The regression equation for predicting LVOTD with the aforementioned variables (LVOTD=6.209+[0.201xSVD]+[1.802xBSA]+[0.03xLVEDD]+[0.025xHeight]) did not differ from (P=0.937) and was highly correlated with measured LVOTD (R=0.739, P<0.001) 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<0.001). 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, avoiding use of LVOT velocity-time integral alone, which can be misleading, especially when LV cavity and aortic root dimensions are abnormal.

Peer review status:ACCEPTED

23 Nov 2020Submitted to Echocardiography
23 Nov 2020Submission Checks Completed
23 Nov 2020Assigned to Editor
25 Nov 2020Reviewer(s) Assigned
07 Jan 2021Editorial Decision: Revise Major
21 Feb 20211st Revision Received
22 Feb 2021Assigned to Editor
22 Feb 2021Submission Checks Completed
25 Feb 2021Reviewer(s) Assigned
26 Mar 2021Review(s) Completed, Editorial Evaluation Pending
29 Mar 2021Editorial Decision: Revise Major
06 Apr 20212nd Revision Received
07 Apr 2021Submission Checks Completed
07 Apr 2021Assigned to Editor
07 Apr 2021Reviewer(s) Assigned
18 Apr 2021Review(s) Completed, Editorial Evaluation Pending
20 Apr 2021Editorial Decision: Revise Minor
26 Apr 20213rd Revision Received
26 Apr 2021Assigned to Editor
26 Apr 2021Submission Checks Completed
26 Apr 2021Reviewer(s) Assigned
06 May 2021Review(s) Completed, Editorial Evaluation Pending
07 May 2021Editorial Decision: Accept