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Increased Left ventricular internal diameter (LVIDd) is an indication for surgery in severe asymptomatic valvular regurgitation. Despite gender specific normal ranges, an absolute value (aLVIDd) is now used. Although intuitively a better parameter, the role of an indexed LVIDd is unknown.
We applied 2 indexed LVIDd parameters (LVIDd/height, LVIDd/BSA) to 831 adult patients with at least moderate mitral or aortic regurgitation, 47.7% women, 35.1% overweight, 26.7% obese. The agreement with aLVIDd for classifying degree of LV dilatation was assessed by weighted Kappa coefficients (κ). Sensitivity and specificity for diagnosing severely dilated LV were calculated.
Substantial agreement found between LVIDd/height and aLVIDd in all patients, and when divided by gender, BMI, age, and LVEF (κ > 0.72 for all). In contrast, substantial agreement found between LVIDd/BSA and aLVIDd only in normal BMI (κ = 0.63), while moderate agreement found in all patients (κ=0.51), females (κ = 0.54), males (κ = 0.48), overweight (κ = 0.60), those younger than (κ = 0.48) and 74 years or older (κ = 0.55), and those with LVEF ≤ 40% (κ = 0.47). Only fair agreement found between LVIDd/BSA and aLVIDd in obese (κ = 0.25) and those with LVEF>40% (κ = 0.40). The sensitivity of LVIDd/height for detecting severely dilated LV was significantly higher than that of LVIDd/BSA in all patients (98.41% vs 44.44% p<0.0001), with similar specificity and positive predictive value (95.3% vs 97.9%, 63.3% vs 63.6%). These findings remain the same when separating patients by gender, BMI, age or LVEF. Only in normal BMI similar sensitivities found (100% vs 93.75%). Using aLVIDd as gold standard, LVIDd/height identified severely dilated LV in all but 1 obese male <74 years old with LVEF ≤ 40%. In addition, LVIDd/height identified 36 patients with severely dilated LV not identified by aLVIDd, of them 23 were males, 9 overweight, 15 obese, 19 of age 74 or older and 26 with LVEF ≤ 40%.
LVIDd/height greatly agreed with aLVIDd for classifying LV size in diverse patients. It is significantly more sensitive than LVIDd/BSA for detection of severely dilated LV, and was able to identify patients missed by current criteria.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Multimodality Imaging in Valvular Heart Disease
Abstract Category: 18. Imaging: Echo
Presentation Number: 1270-348
- 2013 American College of Cardiology Foundation