Binder T M, Rosenhek R, Porenta G, Maurer G, Baumgartner H
Department of Cardiology, University of Vienna, Austria.
J Am Coll Cardiol. 2000 Oct;36(4):1355-61. doi: 10.1016/s0735-1097(00)00852-4.
This study was performed to determine the feasibility, accuracy and reproducibility of real-time volumetric three-dimensional echocardiography (3-D echo) for the estimation of mitral valve area in patients with mitral valve stenosis.
Planimetry of the mitral valve area (MVA) by two-dimensional echocardiography (2-D echo) requires a favorable parasternal acoustic window and depends on operator skill. Transthoracic volumetric 3-D echo allows reconstruction of multiple 2-D planes in any desired orientation and is not limited to parasternal acquisition, and could thus enhance the accuracy and feasibility of calculating MVA.
In 48 patients with mitral stenosis (40 women; mean age 61 +/- 13 years) MVA was determined by planimetry using volumetric 3-D echo and compared with measurements obtained by 2-D echo and Doppler pressure half-time (PHT). All measurements were performed by two independent observers. Volumetric data were acquired from an apical view.
Although 2-D echo allowed planimetry of the mitral valve in 43 of 48 patients (89%), calculation of the MVA was possible in all patients when 3-D echo was used. Mitral valve area by 3-D echo correlated well with MVA by 2-D echo (r = 0.93, mean difference, 0.09 +/- 0.14 cm2) and by PHT (r = 0.87, mean difference, 0.16 +/- 0.19 cm2). Interobserver variability was significantly less for 3-D echo than for 2-D echo (SD 0.08cm2 versus SD 0.23cm2, p < 0.001). Furthermore, it was much easier and faster to define the image plane with the smallest orifice area when 3-D echo was used.
Transthoracic real-time volumetric 3-D echo provides accurate and highly reproducible measurements of mitral valve area and can easily be performed from an apical approach.
本研究旨在确定实时容积三维超声心动图（3D 超声）评估二尖瓣狭窄患者二尖瓣面积的可行性、准确性及可重复性。
二维超声心动图（2D 超声）测量二尖瓣面积（MVA）需良好的胸骨旁声窗且依赖操作者技术。经胸容积 3D 超声可在任意所需方向重建多个二维平面，不限于胸骨旁采集，因此可提高计算 MVA 的准确性和可行性。
对 48 例二尖瓣狭窄患者（40 例女性；平均年龄 61±13 岁），采用容积 3D 超声通过面积测量法测定 MVA，并与 2D 超声及多普勒压力减半时间（PHT）测量结果进行比较。所有测量均由两名独立观察者完成。容积数据从心尖视图获取。
尽管 2D 超声能对 48 例患者中的 43 例（89%）进行二尖瓣面积测量，但使用 3D 超声时所有患者均可计算 MVA。3D 超声测得的二尖瓣面积与 2D 超声测得的 MVA 相关性良好（r = 0.93，平均差值 0.09±0.14 cm²），与 PHT 测得的 MVA 相关性也良好（r = 0.87，平均差值 0.16±0.19 cm²）。3D 超声的观察者间变异性显著小于 2D 超声（标准差分别为 0.08cm²和 0.23cm²，p < 0.001）。此外，使用 3D 超声时更容易且更快地确定最小开口面积的图像平面。
经胸实时容积 3D 超声可提供准确且高度可重复的二尖瓣面积测量，并且可轻松从心尖途径进行操作。
