Aortic valve type and calcification as assessed by transthoracic and transoesophageal echocardiography

Summary Introduction Aortic valve calcification ( AVC ) may predict poor outcome. Bicuspid aortic valve ( BAV ) leads to several haemodynamic changes accelerating the progress of aortic valve ( AV ) disease. Aims To compare the diagnostic accuracy of transoesophageal echocardiography ( TEE ) and transthoracic echocardiography ( TTE ) in the assessment of aortic valve phenotype and degree of AVC , with intra‐operative evaluation as a reference. Methods We examined 169 patients (median age 65 years, 51 women) without significant coronary artery disease undergoing AV and/or aortic root surgery. TTE was performed within a week prior to surgery and TEE at the time of surgery. Results Compared with surgical AVC assessment, visual evaluation using a 5‐grade scoring system and real‐time images showed a higher correlation ( TTE r  =   0·83 and TEE r  =   0·82) than visual ( TTE r  =   0·64 and TEE 0·63) or grey scale mean ( GSM n) ( TTE r  =   0·63 and TEE r  =   0·52) assessment of end‐diastolic still frames. AVC assessment using real‐time images showed high intraclass correlation coefficients ( TTE 0·94 and TEE 0·93). With regard to BAV , TEE was superior to TTE with a higher interobserver agreement, sensitivity and specificity (0·86, 92% and 94% versus 0·57, 77% and 82%, respectively). Conclusion Semi‐quantitative AVC assessment of real‐time cine loops from both TEE and TTE correlated well with intra‐operative evaluation of AVC . Applying a predefined scoring system for AVC evaluation assures a high interobserver correlation. TEE was superior to TTE for evaluation of valve phenotype and should be considered when a diagnosis of BAV is clinically important.