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Diagnostics
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Structural Heart Disease: Diagnosis & Treatment
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Structural Heart Disease: Diagnosis & Treatment

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 10947

Special Issue Editor

Dr. Tobias Friedrich Ruf

E-Mail Website
Guest Editor
Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
Interests: mitral valve regurgitation; leaflet; tricuspid valve disease

Special Issue Information

Dear Colleagues,

Today, searching pubmed.ncbi.nlm.nih.gov for "structural heart disease" in the title/abstract yielded just over 4,400 hits. Indeed, the topic was first mentioned in 1949. Since then, an ever-increasing publication curve can be appreciated, with a maximum publication rate of 311 reached in 2021. It is unlikely that physicians in the 1940s had the same notion of structural heart disease that we do now owing to the volution of the term.

The question may remain to some: what exactly is Structural Heart disease? A useful framework for considering this question might be, that any pathology affecting the structure of the heart is included in the definition, thus spawning different types of structural heart disease: congenital heart sisease, valvular heart disease, and diseases to the cardiac chambers. In order not to create a peacockish synonym for Cardiology in general, it might be prudent to also add the prerequisite of an interventional treatment available. However, this is not exact.

All the more important, that this Special Issue of Diagnostics is dedicated to this vastly growing field in cardiology. A field, it is noted, that still defies definition—perhaps because the interventional possibilities that certainly are strong drivers of the field continue to innovate so quickly.

We can, and should be, excited.

Dr. Tobias Friedrich Ruf
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Published Papers (3 papers)

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11 pages, 1839 KiB  
Article
Impact of Aortic Valve Regurgitation on Doppler Echocardiographic Parameters in Patients with Severe Aortic Valve Stenosis
by Joscha Kandels, Michael Metze, Andreas Hagendorff and Stephan Stöbe
Diagnostics 2023, 13(11), 1828; https://doi.org/10.3390/diagnostics13111828 - 23 May 2023
Cited by 1 | Viewed by 3445
Abstract
Background: Diagnosing severe aortic stenosis (AS) depends on flow and pressure conditions. It is suspected that concomitant aortic regurgitation (AR) has an impact on the assessment of AS severity. The aim of this study was to analyze the impact of concomitant AR on [...] Read more.
Background: Diagnosing severe aortic stenosis (AS) depends on flow and pressure conditions. It is suspected that concomitant aortic regurgitation (AR) has an impact on the assessment of AS severity. The aim of this study was to analyze the impact of concomitant AR on Doppler-derived guideline criteria. We hypothesized that both transvalvular flow velocity (maxVAV) and the mean pressure gradient (mPGAV) will be affected by AR, whereas the effective orifice area (EOA) and the ratio between maximum velocity of the left ventricular outflow tract and transvalvular flow velocity (maxVLVOT/maxVAV) will not. Furthermore, we hypothesized that EOA (by continuity equation), and the geometric orifice area (GOA) (by planimetry using 3D transesophageal echocardiography, TEE), will not be affected by AR. Methods and Results: In this retrospective study, 335 patients (mean age 75.9 ± 9.8 years, 44% male) with severe AS (defined by EOA < 1.0 cm2) who underwent a transthoracic and transesophageal echocardiography were analyzed. Patients with a reduced left ventricular ejection fraction (LVEF < 53%) were excluded (n = 97). The remaining 238 patients were divided into four subgroups depending on AR severity, and they were assessed using pressure half time (PHT) method: no, trace, mild (PHT 500–750 ms), and moderate AR (PHT 250–500 ms). maxVAV, mPGAV and maxVLVOT/maxVAV were assessed in all subgroups. Among the four subgroups (no (n = 101), trace (n = 49), mild (n = 61) and moderate AR (n = 27)), no differences were obtained for EOA (no AR: 0.75 cm2 ± 0.15; trace AR: 0.74 cm2 ± 0.14; mild AR: 0.75 cm2 ± 0.14; moderate AR: 0.75 cm2 ± 0.15, p = 0.998) and GOA (no AR: 0.78 cm2 ± 0.20; trace AR: 0.79 cm2 ± 0.15; mild AR: 0.82 cm2 ± 0.19; moderate AR: 0.83 cm2 ± 0.14, p = 0.424). In severe AS with moderate AR, compared with patients without AR, maxVAV (p = 0.005) and mPGAV (p = 0.022) were higher, whereas EOA (p = 0.998) and maxVLVOT/maxVAV (p = 0.243) did not differ. The EOA was smaller than the GOA in AS patients with trace (0.74 cm2 ± 0.14 vs. 0.79 cm2 ± 0.15, p = 0.024), mild (0.75 cm2 ± 0.14 vs. 0.82 cm2 ± 0.19, p = 0.021), and moderate AR (0.75 cm2 ± 0.15 vs. 0.83 cm2 ± 0.14, p = 0.024). In 40 (17%) patients with severe AS, according to an EOA < 1.0 cm2, the GOA was ≥ 1.0 cm2. Conclusion: In severe AS with moderate AR, the maxVAV and mPGAV are significantly affected by AR, whereas the EOA and maxVLVOT/maxVAV are not. These results highlight the potential risk of overestimating AS severity in combined aortic valve disease by only assessing transvalvular flow velocity and the mean pressure gradient. Furthermore, in cases of borderline EOA, of approximately 1.0 cm2, AS severity should be verified by determining the GOA. Full article
(This article belongs to the Special Issue Structural Heart Disease: Diagnosis & Treatment)
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11 pages, 3886 KiB  
Article
Benefit of 3D Vena Contracta Area over 2D-Based Echocardiographic Methods in Quantification of Functional Mitral Valve Regurgitation
by Vinzenz M. Jungels, Felix M. Heidrich, Christian Pfluecke, Axel Linke and Krunoslav M. Sveric
Diagnostics 2023, 13(6), 1176; https://doi.org/10.3390/diagnostics13061176 - 19 Mar 2023
Cited by 2 | Viewed by 4134
Abstract
Background: The two-dimensional proximal isovelocity surface area (2D PISA) method in the quantification of an effective regurgitation orifice area (EROA) has limitations in functional mitral valve regurgitation (FMR), particularly in non-circular coaptation defects. Objective: We aimed to validate a three-dimensional vena contracta area [...] Read more.
Background: The two-dimensional proximal isovelocity surface area (2D PISA) method in the quantification of an effective regurgitation orifice area (EROA) has limitations in functional mitral valve regurgitation (FMR), particularly in non-circular coaptation defects. Objective: We aimed to validate a three-dimensional vena contracta area (3D VCA) against a conventional EROA using a 2D PISA method and anatomic regurgitation orifice area (AROA) in patients with FMR. Methods: Both 2D and 3D full-volume color Doppler data were acquired during consecutive transoesophageal echocardiography (TEE) examinations. The EROA 2D PISA was calculated as recommended by current guidelines. Multiplanar reconstruction was used for offline analysis of the 3D VCA (with a color Doppler) and AROA (without a color Doppler). Receiver operating characteristic (ROC) analysis was used to calculate a cut-off value for the 3D VCA to discriminate between moderate and severe FMR as classified by the EROA 2D PISA. Results: From 2015 to 2018, 105 consecutive patients with complete and adequate imaging data were included. The 3D VCA correlated strongly with the 2D PISA EROA and AROA (r = 0.93 and 0.94). In the presence of eccentric or multiple regurgitant jets, there was no significant difference in correlations with the 3D VCA. We found a 3D VCA cut-off of 0.43 cm2 to discriminate between moderate and severe FMR (area under curve = 0.98). The 3D VCA showed a higher interobserver agreement than the EROA 2D PISA (interclass correlation coefficient: 0.94 vs. 0.81). Conclusions: The 3D VCA has excellent validity and lower variability than the conventional 2D PISA in FMR. Compared to the 2D PISA, the 3D VCA was not affected by the presence of eccentric or multiple regurgitation jets or non-circular regurgitation orifices. With a threshold of 0.43 cm2 for the 3D VCA, we demonstrated reliable discrimination between moderate and severe FMR. Full article
(This article belongs to the Special Issue Structural Heart Disease: Diagnosis & Treatment)
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16 pages, 8234 KiB  
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Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases—Possible or Wishful Thinking?
by Andreas Hagendorff, Joscha Kandels, Michael Metze, Bhupendar Tayal and Stephan Stöbe
Diagnostics 2023, 13(7), 1359; https://doi.org/10.3390/diagnostics13071359 - 6 Apr 2023
Cited by 3 | Viewed by 2584
Abstract
The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes [...] Read more.
The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes and regurgitant fraction. In the literature, there is an ongoing discussion about differences between cardiac volumes estimated by echocardiography and cardiac magnetic resonance tomography. This viewpoint focuses on the feasibility to assess comparable cardiac volumes with both modalities. The former underestimation of cardiac volumes determined by 2D and 3D echocardiography is presumably explained by methodological and technical limitations. Thus, this viewpoint aims to stimulate an urgent and critical rethinking of the echocardiographic assessment of patients with valvular heart diseases, especially valvular regurgitations, because the actual integrative approach might be too error prone to be continued in this form. It should be replaced or supplemented by a definitive quantitative approach. Valid quantitative assessment by echocardiography is feasible once echocardiography and data analysis are performed with methodological and technical considerations in mind. Unfortunately, implementation of this approach cannot generally be considered for real-world conditions. Full article
(This article belongs to the Special Issue Structural Heart Disease: Diagnosis & Treatment)
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