Weissman N J, Panza J A, Tighe J F, Perras S T, Kushner H, Gottdiener J S
Cardiovascular Research Institute, Washington Hospital Center, DC, USA.
J Am Coll Cardiol. 2001 May;37(6):1614-21. doi: 10.1016/s0735-1097(01)01222-0.
We sought to determine the specificity of two different methods for assessing change in aortic (AR), mitral (MR) and tricuspid (TR) valvular regurgitation.
Echocardiographic imaging with Doppler is the standard noninvasive diagnostic tool for assessing valvular structure and function. Change can be assessed using either independent evaluations (serial) or using a side-by-side comparison.
Subjects were from the placebo arm of a randomized, double-blind, clinical trial. Three echocardiograms over 10 months were performed. An initial and three-month echocardiogram were read as independent groups, blinded to all parameters except sequence. The initial and 10-month echocardiograms were read side-by-side, blinded to all parameters including sequence.
Two hundred nineteen predominantly healthy, obese, white, middle-aged women had initial and three-month echocardiograms (acquisition interval 105 +/- 28 days) evaluated by the serial method (mean 167 +/- 61 days between interpretations). The same subjects had the initial and 10-month studies (acquisition interval 303 +/- 27 days) compared side-by-side. The specificity of the serial versus side-by-side method for determining change in MR grade was 55.8% versus 93.2% (p < 0.001); TR: 63.8% versus 97.6% (p < 0.001) and AR: 93.7% versus 97.6 (p = 0.08). Notably, most of the change occurred in a range (none versus physiologic/mild) that has limited clinical significance. Furthermore, the percentage of echocardiograms interpreted as nonevaluable was lower with the side-by-side method for MR (5.0% vs. 16.0%, p = 0.06), TR (4.6% vs. 15.5%, p < 0.001) and AR (4.1% vs. 12.3%, p = 0.002).
The side-by-side method of assessing change in valvular regurgitation appears to be the more reliable method with a higher specificity and minimal data loss.
我们试图确定两种不同方法评估主动脉瓣反流（AR）、二尖瓣反流（MR）和三尖瓣反流（TR）变化的特异性。
采用多普勒的超声心动图成像技术是评估瓣膜结构和功能的标准无创诊断工具。变化可以通过独立评估（系列评估）或并排比较来评估。
研究对象来自一项随机、双盲临床试验的安慰剂组。在10个月内进行了三次超声心动图检查。首次和三个月时的超声心动图作为独立组进行解读，除序列外对所有参数均设盲。首次和10个月时的超声心动图进行并排解读，对包括序列在内的所有参数均设盲。
219名主要为健康、肥胖、白人、中年女性接受了首次和三个月时的超声心动图检查（采集间隔105±28天），采用系列评估法（两次解读之间平均间隔167±61天）。相同的研究对象接受了首次和10个月时的检查（采集间隔303±27天）并进行并排比较。系列评估法与并排比较法确定MR分级变化的特异性分别为55.8%和93.2%（p<0.001）；TR分别为63.8%和97.6%（p<0.001）；AR分别为93.7%和97.6%（p=0.08）。值得注意的是，大多数变化发生在一个临床意义有限的范围内（无反流与生理性/轻度反流）。此外，对于MR，并排比较法解读为无法评估的超声心动图百分比更低（5.0%对16.0%，p=0.06），TR为（4.6%对15.5%，p<0.001），AR为（4.1%对12.3%，p=0.002）。
并排评估瓣膜反流变化的方法似乎是更可靠的方法，具有更高的特异性和最小的数据丢失。
