实时三维经食管超声心动图对二尖瓣脱垂瓣器结构与反流程度的定量研究

Quantitative study of valve structure and degree of regurgitation in mitral valve prolapse by RT-3D-TEE

目的应用实时三维经食管超声心动图(RT-3D-TEE)评估二尖瓣脱垂病变瓣器结构改变与反流程度之间的相关性。方法纳入于我院就诊行经胸超声心动图检查确诊为二尖瓣脱垂伴反流的患者40例,另选取10例作为对照组。50例患者均行RT-3D-TEE检查并采集二尖瓣三维图像,使用4D AutoMVQ脱机工作站进行图像后处理和定量分析。结果瓣环三维面积、瓣环二维面积、瓣环周长、前后直径、前外-后内侧直径、非平面角度、总瓣叶面积、后叶面积随反流程度增加而增大,瓣高联合比随反流程度增加而减小,组间差异均有统计学意义(P<0.05)。瓣环三维面积、瓣环二维面积、瓣环周长、前后直径、总瓣叶面积与反流程度呈极强相关关系(r=0.847、0.843、0.845、0.854、0.854,P<0.05)。A Total是导致重度二尖瓣反流发生的危险因素(P<0.01,B=1.576,OR=4.834)。总瓣叶面积(截点值=8.9 cm2)预测重度二尖瓣反流的敏感度为91.7%,特异性为87.5%,曲线下面积为0.948(P<0.01)。结论二尖瓣瓣环大小、扁平程度、瓣叶大小与反流程度呈正相关。总瓣叶面积是导致二尖瓣脱垂患者二尖瓣反流程度加重的危险因素。

Objective To evaluate the correlation between valve structure changes and the degree of mitral regurgitation,and predict the risk factors for aggravating the degree of regurgitation in patients with mitral valve prolapse via real-time three-dimensional transesophageal echocardiography(RT-3D-TEE).Methods Forty patients who were diagnosed as mitral valve prolapse with mitral valve regurgitation by transthoracic echocardiography,and 10 volunteers in our hospital were involved.All the 50 enrolled patients underwent RT-3D-TEE and the three-dimensional images of the mitral valve were collected.Then the 4D Auto MVQ offline workstation was used for image post-processing and quantitative analysis.Results Annulus area 3D,annulus area 2D,annulus perimeter,anterior-to-posterior diameter,anterolateral to posteromedial diameter,non-planar angle,total leaflet area(A Total),posterior leaflet area increased and annular height to commissural width ratio decreased with the increase of the degree of regurgitation.The differences between two groups were statistically significant(P<0.05).Annulus area 3D、annulus area 2D、annulus perimeter、anterior-to-posterior diameter、A Total were extremely strongly correlated with the degree of mitral regurgitation(r=0.847,0.843,0.845,0.854,0.854 respectively,P<0.05).A Total was a risk factor for severe mitral regurgitation(P<0.01,B=1.576,OR=4.834).The sensitivity of A Total(cut point value=8.9 cm2)in predicting severe mitral regurgitation was 91.7%,the specificity was 87.5%,and the area under the curve was 0.948(P<0.01).Conclusion The size of the mitral valve annulus,the degree of flattening and the size of the valve leaflet were positively correlated with the degree of regurgitation.Among them,A Total is a risk factor for the aggravation of mitral regurgitation in patients with mitral valve prolapse.