实时三平面超声心动图定量评价二尖瓣反流的临床研究

Quantitative evaluation of mitral regurgitation by real-time tri-plane echocardiography

目的探讨实时三平面超声心动图(RT-3PE)定量评价二尖瓣反流的临床价值。方法依据左室造影瓣膜反流程度,将40例二尖瓣反流患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四组,同时应用RT-3PE技术测量二尖瓣彩色反流束容积/左房容积(RJV/LAV)、血流汇聚法测量反流分数(RF)以及二维彩色多普勒面积法测量最大反流束面积/左心房面积(RJA/LAA),所得数值进行相应分级并与左室造影分级进行比较。结果40例二尖瓣反流患者中,12例为偏心性反流,28例为中心性反流。与左室造影相比,RT-3PE对于二尖瓣反流程度Ⅰ、Ⅱ、Ⅲ、Ⅳ级的判断符合率分别为100%、78%、80%、85%(Kappa值79.87%);FC法分别为86%、67%、78%、79%(Kappa值69.88%);RJA/LAA法分别为86%、67%、63%、69%(Kappa值60%)。在12例偏心性反流中,RT-3PE法低估3例,符合率为75%;FC法低估3例、高估2例,符合率为58%;RJA/LAA低估6例,符合率为50%。结论RT-3PE为定量评价二尖瓣反流、特别是偏心性二尖瓣反流提供了一种简便、准确的方法。

Objective To assess the clinical feasibility of quantitative evaluation of mitral regurgitation by real-time triplane echocardiography （RT-3PE）. Methods Forty patients with mitral regurgitation were assigned to 4 groups based on the angiographic regurgitation degree. Meanwhile, the regurgitation jet volume/left atrium volume （RJV/LAV） by RT- 3PE, the regurgitation fraction （RF） by 2-dimensional color Doppler flow convergence （FC） method and the maximal regur gitation jet area/left atrium area （RJA/LAA） by 2-dimensional color Doppler were also obtained and their semi-quantitative classification was compared with angiographic classification. Results Of 40 patients, 12 had eccentric jets and 28 had central jets. Compared with angiographic degree of mitral regurgitation, the coincidence of Ⅰ , Ⅱ , Ⅲ, Ⅳ degree were 100%, 78%, 80%, 85% by RT-3PE （Kappa value=79.87%）, 86%, 67%, 78%, 79% by FC （Kappa value= 69.88%）, and 86%, 67%, 63%, 69% by RJA/LAA（Kappa value=60%） respectively. Of 12 patients with eccentric jets, the coincidence by RT-3PE was 75% with 3 underestimated, that by FC was 68% with 3 underestimated and 2 overestimated, and that by RJA/LAA was 50% with 6 underestimated. Conclusion RT-3PE is a convenient, accurate and reliable modality in quantitative evaluation for mitral regurgitation, especially for eccentric regurgitation jets.