Author + information
- Received March 12, 2015
- Revision received May 19, 2015
- Accepted June 11, 2015
- Published online March 1, 2016.
- Federico M. Asch, MDa,∗ (, )
- Eugene Yuriditsky, MDa,
- Siddharth K. Prakash, MD, PhDb,
- Mary J. Roman, MDc,
- Jonathan W. Weinsaft, MDc,
- Gaby Weissman, MDa,
- Wm. Guy Weigold, MDa,
- Shaine A. Morris, MD, MPHd,
- William J. Ravekes, MDe,
- Kathryn W. Holmes, MDf,
- Michael Silberbach, MDf,
- Rita K. Milewski, MD, PhDg,
- Barbara L. Kroner, PhD, MPHh,
- Ryan Whitworth, MPHh,
- Kim A. Eagle, MDi,
- Richard B. Devereux, MDc,
- Neil J. Weissman, MDa,
- GenTAC Investigators
- aMedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC
- bUniversity of Texas, Houston, Houston, Texas
- cWeill Cornell Medical College, New York, New York
- dBaylor College of Medicine, Houston, Texas
- eJohns Hopkins School of Medicine, Baltimore, Maryland
- fOregon Health & Science University, Portland, Oregon
- gUniversity of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- hRTI International, Rockville, Maryland
- iUniversity of Michigan, Ann Arbor, Michigan
- ↵∗Reprint requests and correspondence:
Dr. Federico M. Asch, Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, 100 Irving Street, NW, Suite EB 5123, Washington, DC 20010.
Objectives This study sought to evaluate variability in aortic measurements with multiple imaging modalities in clinical centers by comparing with a standardized measuring protocol implemented in a core laboratory.
Background In patients with aortic disease, imaging of thoracic aorta plays a major role in risk stratifying individuals for life-threatening complications and in determining timing of surgical intervention. However, standardization of the procedures for performance of aortic measurements is lacking.
Methods To characterize the diversity of methods used in clinical practice, we compared aortic measurements performed by echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) at the 6 GenTAC (National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) clinical centers to those performed at the imaging core laboratory in 965 studies. Each center acquired and analyzed their images according to local protocols. The same images were subsequently analyzed blindly by the core laboratory, on the basis of a standardized protocol for all imaging modalities. Paired measurements from clinical centers and core laboratory were compared by mean of differences and intraclass correlation coefficient (ICC).
Results For all segments of the ascending aorta, echocardiography showed a higher ICC (0.84 to 0.93) than CT (0.84) and MRI (0.82 to 0.90), with smaller mean of differences. MRI showed higher ICC for the arch and descending aorta (0.91 and 0.93). In a mixed adjusted model, the different imaging modalities and clinical centers were identified as sources of variability between clinical and core laboratory measurements, whereas age groups or diagnosis at enrollment were not.
Conclusions By comparing core laboratory with measurements from clinical centers, our study identified important sources of variability in aortic measurements. Furthermore, our findings with regard to CT and MRI suggest a need for imaging societies to work toward the development of unifying acquisition protocols and common measuring methods.
A full list of the GenTAC Investigators are listed in the Online Appendix.
The GenTAC Registry has been supported in total by U.S. Federal Government contracts HHSN268200648199C and HHSN268201000048C from the National Heart, Lung, and Blood Institute and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Bethesda, Maryland).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 12, 2015.
- Revision received May 19, 2015.
- Accepted June 11, 2015.
- American College of Cardiology Foundation