经胸超声与经食管超声测量主动脉瓣环内径的对比研究

Comparison of transthoracic and transesophageal echocardiography in measurements of aortic valve annulus diameter

目的对比经胸超声(TTE)和经食管超声(TEE)在主动脉瓣环内径(AVAD)测量方面的差异。方法入选我院就诊拟行经导管主动脉瓣置入术(TAVI)的钙化性主动脉瓣狭窄(CAS)患者10例。另外入选同期在我院就诊16例无主动脉瓣狭窄老年患者(>65岁)为对照组。所有患者均行TEE及TTE测量AVAD。结果 CAS组中,TTE测得的AVAD(AVAD-TTE)与TEE测得的AVAD(AVAD-TEE)有很强的相关性(r=0.89,P=0.0005),两者之间的组内相关系数(ICC)为0.88(P=0.002)。与TEE比,TTE低估了AVAD值[(21.55±2.63)mmvs.(22.96±3.04)mm,P=0.01]。有3例患者,AVAD-TTE比AVAD-TEE小3mm或以上。对照组中,AVAD-TEE与AVAD-TTE有更强的相关性(r=0.94,P<0.0001),两者之间的ICC为0.93(P<0.0001)。AVAD-TEE与AVAD-TTE无统计学差异[(21.21±2.85)mmvs.(21.52±2.75)mm,P=0.24]。两者最大差值为2mm,无病例差值≥3mm。无论是在CAS组和对照组,TTE及TEE在测量AVAD时均具有良好的重复性,ICC均>0.95,最大差异不超过1.2mm。结论在CAS患者中,TTE相对于TEE而言易低估AVAD,尤其是在图像质量偏差的患者中。TTE在作为TAVI手术策略参考时尚不能替代TEE。

Objective To compare transthoracic echocardiography（TTE） with transesophageal echocardiography（TEE） in measurement of aorticvalve annulus diameter（AVAD）.Methods Ten patients with calcified aortic stenosis（CAS）planning to transcatheter aortic valve implantation（TAVI） were enrolled in the study.Sixteen cases of elderly patients without CAS（65 years old） was selected as control group.All patients underwent TEE and TTE examination for measurements of AVAD.Results In CAS group,there was a strong correlation between AVAD measured by TEE（AVAD-TEE） and by TTE（AVAD-TTE）（r=0.89,P= 0.0005）.The ICC between two methods was 0.88（P=0.002）.As compared with TEE,TTE underestimated AVAD[（21.55 ± 2.63） mm vs.（22.96 ± 3.04）mm,P=0.01].In 3 patients,AVAD-TTE was 3 mm（or more） less than AVAD-TEE.In control group,the correlation between AVAD-TEE and AVAD-TTE was much stronger（r=0.94,P0.0001）,and the ICC between two methods was 0.93（P0.0001）.There was no significant difference between AVAD-TEE and AVAD-TTE[（21.21±2.85）mm vs.（21.52 ± 2.75） mm,P=0.24].The maximum difference between the two methods was 2 mm,and no cases had difference more than 3 mm.No matters in CAS group or control group,both TTE and TEE had good repeatability for measurement of AVAD.The ICC were all 0.95,and the maximum difference was not more than 1.2 mm.Conclusions In CAS patients,especially in those with bad echocardiographic image quality,TTE tend to underestimate the AVAD as compared with TEE.TTE cannot replace TEE in terms of providing reference information for TAVI.