{"id":116588,"date":"2014-05-11T00:00:00","date_gmt":"2014-05-11T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/ecocardiografia-transesofagica-tridimensional-en-la-evaluacion-de-la-estenosis-valvular-aortica\/"},"modified":"2014-05-11T00:00:00","modified_gmt":"2014-05-11T00:00:00","slug":"ecocardiografia-transesofagica-tridimensional-en-la-evaluacion-de-la-estenosis-valvular-aortica","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/medicina-interna\/ecocardiografia-transesofagica-tridimensional-en-la-evaluacion-de-la-estenosis-valvular-aortica\/","title":{"rendered":"Ecocardiografia transesofagica tridimensional en la evaluacion de la estenosis valvular aortica"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Daniel R. Saura Espin <\/strong><\/h2>\n<p>Objetivos:  determinar la factibilidad de la medida del \u00e1rea valvular a\u00f3rtica anat\u00f3mica mediante la ecocardiograf\u00eda transesof\u00e1gica tridimensional en tiempo real en pacientes con estenosis valvular a\u00f3rtica moderada y severa. Determinar los predictores de la factibilidad. Determinar la concordancia y las desviaciones sistem\u00e1ticas de las t\u00e9cnicas tridimensionales para la cuantificaci\u00f3n del \u00e1rea valvular a\u00f3rtica respecto al m\u00e9todo ecocardiogr\u00e1fico habitual si las hubiere. Describir la concordancia en los criterios de severidad de la estenosis a\u00f3rtica entre el \u00e1rea anat\u00f3mica medida mediante la planimetr\u00eda en el ecocardiograma transesof\u00e1gico tridimensional y los gradientes de presi\u00f3n transvalvular obtenidos por t\u00e9cnicas doppler. Describir las caracter\u00edsticas demogr\u00e1ficas, cl\u00ednicas y ecocardiogr\u00e1ficas de los pacientes con estenosis a\u00f3rtica severa confirmada con planimetr\u00eda en ecocardiograma transesof\u00e1gico tridimensional, y que presenten gradiente sist\u00f3lico transvalvular bajo pese a fracci\u00f3n de eyecci\u00f3n preservada. Describir la consistencia de la clasificaci\u00f3n de la estenosis a\u00f3rtica severa en funci\u00f3n del flujo y el gradiente transvalvular, empleando la informaci\u00f3n anat\u00f3mica proporcionada por el ecocardiograma transesof\u00e1gico tridimensional. Explorar el valor pron\u00f3stico de los datos del ecocardiograma transesof\u00e1gico tridimensional obtenidos en los pacientes con estenosis a\u00f3rtica. metodolog\u00eda: para todos los objetivos salvo el \u00faltimo se llev\u00f3 a cabo un estudio cl\u00ednico de observaci\u00f3n con dise\u00f1o transversal que incluy\u00f3 a 307 pacientes con estenosis valvular a\u00f3rtica moderada o severa que fueron sometidos a ecocardiograma transtor\u00e1cico convencional y asimismo a ecocardiograma transesof\u00e1gico tridimensional en tiempo real para llevar a cabo la planimetr\u00eda del \u00e1rea valvular a\u00f3rtica. Se practic\u00f3 an\u00e1lisis estad\u00edstico de concordancia y an\u00e1lisis de regresi\u00f3n multivariable. Para el \u00faltimo de los objetivos se emple\u00f3 un dise\u00f1o longitudinal con seguimiento prospectivo del mismo grupo de pacientes, con estimaci\u00f3n de las tasas de mortalidad y sus predictores con el m\u00e9todo de kaplan-meier y regresi\u00f3n de cox. resultados y conclusiones:  en una poblaci\u00f3n que representa a la de la pr\u00e1ctica cl\u00ednica habitual con estenosis valvular a\u00f3rtica moderada o severa en nuestro medio, el \u00e1rea valvular a\u00f3rtica anat\u00f3mica pudo ser cuantificada mediante planimetr\u00eda a partir de las im\u00e1genes del ecocardiograma transesof\u00e1gico tridimensional en el 92% de los casos. El grado de calcificaci\u00f3n valvular a\u00f3rtica fue el \u00fanico predictor independiente del fracaso de la t\u00e9cnica de medida. La planimetr\u00eda directa del \u00e1rea valvular a\u00f3rtica tiene buena concordancia con el m\u00e9todo transtor\u00e1cico habitual, e infraestima levemente el valor del orificio valvular respecto al est\u00e1ndar cl\u00ednico. Por otra parte, el c\u00e1lculo del \u00e1rea valvular a\u00f3rtica mediante la ecuaci\u00f3n de continuidad empleando el \u00e1rea del tracto de salida del ventr\u00edculo izquierdo medida en el ecocardiograma transesof\u00e1gico tridimensional tiene una buena concordancia con el m\u00e9todo cl\u00ednico habitual, pero sobreestima el valor del \u00e1rea respecto a \u00e9ste. La determinaci\u00f3n de la severidad de la estenosis valvular a\u00f3rtica mediante el \u00e1rea planimetrada en el ecocardiograma transesof\u00e1gico tridimensional muestra discordancias importantes con la severidad establecida seg\u00fan los gradientes transvalvulares. La inconsistencia de criterios en la valoraci\u00f3n de la severidad de la estenosis valvular a\u00f3rtica existe tanto en los pacientes con fracci\u00f3n de eyecci\u00f3n del ventr\u00edculo izquierdo normal como deprimida. Los pacientes con estenosis a\u00f3rtica severa confirmada con planimetr\u00eda en el ecocardiograma transesof\u00e1gico tridimensional y con gradiente bajo pese a fracci\u00f3n de eyecci\u00f3n normal tienen mayores valores de \u00e1rea valvular a\u00f3rtica dentro del rango severo y peor acoplamiento ventr\u00edculo-arterial. La clasificaci\u00f3n de la estenosis a\u00f3rtica severa en funci\u00f3n del flujo y gradiente transvalvular valorada con ecocardiograma transesof\u00e1gico tridimensional tiene una consistencia s\u00f3lo moderada respecto al est\u00e1ndar cl\u00ednico. El \u00e1rea valvular a\u00f3rtica anat\u00f3mica medida directamente mediante planimetr\u00eda de las im\u00e1genes del ecocardiograma transesof\u00e1gico tridimensional se relaciona de forma independiente con el riesgo de muerte en los pacientes con estenosis a\u00f3rtica moderada o severa.   aims:  to study the feasibility of planimetry of aortic valve area by means of real-time three-dimensional transesophageal echocardiography in patients with moderate and severe aortic stenosis. To determine the predictors of feasibility. To study the reliability and concordance of aortic valve planimetry by three-dimensional echocardiography in comparison with transthoracic echocardiography. To describe the consistency in the severity criteria of aortic stenosis by means of both three-dimensional planimetry and mean systolic gradient. To describe demographic, clinical and echocardiographic characteristics of patients with paradoxical low-gradient severe aortic stenosis as confirmed with planimetry. To describe the reliability of the new proposed classification of severe aortic stenosis regarding systolic flow and transvalvular gradient if anatomical assessment by real-time three-dimensional transesophageal echocardiography were performed. Least, to explore the prognostic value of the information obtained with tested technique. methods: for all objectives but the last one, we performed a clinical observational study with cross-sectional design that included 307 patients with moderate or severe aortic stenosis who underwent both conventional transthoracic echocardiography and real-time three-dimensional transesophageal echocardiography.  Planimetry of aortic valve area from three-dimensional datasets was carried out. Statistical analysis of concordance and multivariate regression analysis was performed. For the last of the objectives, a longitudinal prospective design was used to follow the same group of patients, with estimates of mortality and its predictors with the kaplan-meier and cox regression methods. results and conclusions:  aortic valve area planimetry by means of three-dimensional echocardiography was achieved in 92% of patients with moderate or severe aortic stenosis. The sample was obtained from actual clinical practice. Valvular calcification grade was the only single independent predictor of non-feasibility. Planimetry of aortic valve area shows good agreement with the transthoracic method, and it slightly underestimates the value in comparison with the diagnostic clinical standard. On the other hand, aortic valve area by means of continuity equation (but using the cross-sectional area o left ventricle outflow tract as obtained from three-dimensional datasets) has fair reliability as compared with the clinical standard, but it overestimates the measurement. Aortic stenosis severity grading by three-dimensional planimetry and transvalvular mean systolic gradient showed clinically significant discordances; such disagreement was found both in patients with normal and depressed systolic function. Patients with paradoxical low-gradient severe aortic stenosis (as confirmed by three-dimensional planimetry) show higher aortic valve area values (within severity range) and worse ventricular-arterial coupling parameters. The classification of severe aortic stenosis depending on both flow and transvalvular gradient assessed by three-dimensional transesophageal echocardiography shows only moderate consistency as compared with the clinical standard. The anatomic aortic valve area measured directly by planimetry of the images of three-dimensional transesophageal echocardiography is associated independently with the risk of death in patients with moderate or severe aortic stenosis.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Ecocardiografia transesofagica tridimensional en la evaluacion de la estenosis valvular aortica<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Ecocardiografia transesofagica tridimensional en la evaluacion de la estenosis valvular aortica <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Daniel R. Saura Espin <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 05\/11\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Mar\u00eda no Valdes Chavarri<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Juan  Antonio Ruiperez abizanda <\/li>\n<li>Miguel angel Garcia fernandez (vocal)<\/li>\n<li>M\u00aa Jos\u00e9 Oliva sandoval (vocal)<\/li>\n<li>joaqu\u00edn Barba cosials (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Daniel R. Saura Espin Objetivos: determinar la factibilidad de la medida del \u00e1rea valvular a\u00f3rtica anat\u00f3mica mediante [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[932,346,139,8235],"tags":[230099,18054,8837,8243,145106,216210],"class_list":["post-116588","post","type-post","status-publish","format-standard","hentry","category-cardiologia","category-diagnostico-por-imagen","category-medicina-interna","category-murcia","tag-daniel-r-saura-espin","tag-joaquin-barba-cosials","tag-juan-antonio-ruiperez-abizanda","tag-maria-no-valdes-chavarri","tag-miguel-angel-garcia-fernandez","tag-ma-jose-oliva-sandoval"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116588","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=116588"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116588\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=116588"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=116588"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=116588"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}