Quantitative assessment of hypertrophic obstructive cardiomyopathy with intraoperative three-dimensional epicardial and transesophageal echocardiography
Bibliographic record
Abstract
Background: Hypertrophic obstructive cardiomyopathy (HOCM), a subset of hypertrophic cardiomyopathy (HCM), is characterized by dynamic left ventricular outflow tract (LVOT) obstruction, often caused by systolic anterior motion (SAM) of the mitral valve and septal hypertrophy. Accurate intraoperative assessment of septal morphology, SAM distance, and LVOT area (LVOTa) is critical for surgical planning during septal myectomy. While transesophageal echocardiography (TEE), particularly with three-dimensional (3D) imaging, is the standard modality for evaluating these parameters, it may be contraindicated or suboptimal in select cases. Real-time 3D epicardial echocardiography (EE) offers an alternative imaging approach that allows direct visualization of the heart intraoperatively without esophageal instrumentation. This study investigates the utility of 3D EE compared to 3D TEE for quantitative assessment of septal left ventricular wall thickness (LVWT), SAM distance, and LVOTa in HOCM patients undergoing myectomy. The primary aim is to assess whether 3D EE and TEE measurements correlate and can be used interchangeably. A secondary aim is to compare 2D and 3D measurements by both modalities. Methods: Perioperative data of 59 patients with HOCM were obtained by retrospective review in a tertiary care setting. 2D and 3D intraoperative transesophageal and EE studies were assessed performing multiple measurements relevant for myectomy. Demographic and clinical data were summarized with descriptive statistics, while the Altman-Bland method assessed the interchangeability of three-dimensional transesophageal and EE measurements. Inter- and intraobserver variabilities were evaluated using the Bland-Altman method and intraclass correlation coefficient. Results: Off-line analysis of 3D data sets with Qlab Phillips was feasible in 79.7% of the patients. No significant differences were found between epicardial and transesophageal echocardiographic intraoperative measurements by 2D: septal LVWT (P=0.59), SAM distance (P=0.40) or LVOTa (P=0.22), or by 3D: septal LVWT (P=0.42), SAM distance (P=0.23) or LVOTa (P=0.38). Conclusions: Intraoperative EE demonstrates equal potential utility in guiding HOCM patients when TEE is not an option or is contraindicated. These findings underscore the clinical significance of EE as a reliable alternative for image guidance during myectomy in HOCM patients, contributing to improved surgical outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".