RT-3DE评价风湿性二尖瓣狭窄瓣口面积的初步探讨

Assessment of MVA in patients with rheumatic mitral stenosis by real time three-dimensional echocardiography

目的探讨实时三维超声心动图评价风湿性二尖瓣狭窄面积的可行性。方法选取23例健康志愿者为对照组;根据临床诊断结果 21例风湿性二尖瓣狭窄患者为病例组。分别应用二维法和实时三维容积法测量病例组二尖瓣瓣口面积,并比较两者测量方法的差异。绘制ROC曲线,对实时三维容积法测量诊断效能进行评价。2名测量者测量结果进行一致性检验。结果比较病例组与对照组测量的二尖瓣口面积,差异有统计学意义。病例组中二维和三维测量值的ROC曲线下面积比较,二者的诊断效能比较差异无统计学意义(P>0.05)。2名测量者测量结果一致性良好(k=0.789,0.777,0.787,0.786)。结论实时三维超声心动图评价风湿性二尖瓣狭窄面积具有可行性和可重复性,为临床风湿性二尖瓣狭窄瓣口面积的评价提供了一种新的测量方法。

Objective To explore the feasibility of real-time three-dimensional echocardiography in mitral stenosis. Methods Twenty-three healthy volunteers were included as control group. The mitral stenosis group consisted of 21 patients. They were divided into two groups： 2D group and RT-3DE group. Mitral valve orifice area （MVA） was calculated. Receiver-operating characteristic （ROC） eourve was drawn to assess the diagnostic efficiency. Interobserver agreement for MVA was calculated using the Kappa statistic. Results There were significant differences of the MVA between patient group and volunteer group （ P 〈 0. 001 ）. The area under the curve （AUC） of MVA indicated that 2D was higher than RT-3DE in diagnosis of mitral stenosis （AUC 〉 0. 8）. No significant difference of diagnostic value was found between 2D and RT-3DE （ P 〉 0. 05 ）. Interobserver agreement was good （ k = 0.789, 0.777, 0.787, 0. 786）. Conclusion RT-3DE showed its feasibility in mitral stenosis evaluation. It could be used to assess the MVA and may be a supplement method for clinical diagnostics.