Neuman Yoram M, Brasch Andrea V, Kobal Sergio, Khan Steven S, Mirocha James M, Naqvi Tasneem Z, Siegel Robert J
Department of Medicine, Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Cardiology. 2003;99(3):145-52. doi: 10.1159/000070671.
We examined the agreement between transthoracic echocardiography (TTE) and intraoperative prepump transesophageal echocardiography (TEE) in the assessment of left-sided regurgitant lesions and echocardiographic variables associated with grading discrepancies.
The TTE and prepump TEE studies of 54 patients undergoing aortic-valve replacement for aortic stenosis were reviewed. Agreement and correlation in assessment of aortic (AR) and mitral regurgitation (MR) severity were evaluated.
There was no significant difference between mean TTE and prepump TEE grading of MR (0.23 +/- 0.19 vs. 0.21 +/- 0.15 jet area/area of the left atrium, p = 0.49), but the correlation between the two methods was weak (r = 0.40, p = 0.003), with an exact agreement of 54%. Prepump TEE tended to grade AR as more severe (mean grade 1.43 +/- 0.94 vs. 1.24 +/- 0.75, p = 0.058). The correlation between the two methods in AR assessment was fair (r = 0.70, p = 0.0001) with an agreement of 59%. For MR and AR grading, no significant correlations between valvular regurgitation severity and blood pressure differences between preoperative TTE and prepump TEE were found. In 17% of cases, discrepancies in identifying severe mitral or aortic valve regurgitation could have affected patient management.
There is modest agreement in MR and AR assessment between TTE and prepump TEE. Cardiologists, cardiac surgeons, and anesthesiologists must be aware of differences between these methods when using prepump TEE to guide intraoperative decisions.
我们研究了经胸超声心动图（TTE）与术中预充泵经食管超声心动图（TEE）在评估左侧反流性病变以及与分级差异相关的超声心动图变量方面的一致性。
回顾了54例因主动脉瓣狭窄接受主动脉瓣置换术患者的TTE和预充泵TEE检查结果。评估了主动脉反流（AR）和二尖瓣反流（MR）严重程度评估中的一致性和相关性。
TTE和预充泵TEE对MR的平均分级之间无显著差异（0.23±0.19对0.21±0.15，即反流束面积/左心房面积，p = 0.49），但两种方法之间的相关性较弱（r = 0.40，p = 0.003），完全一致率为54%。预充泵TEE倾向于将AR分级为更严重（平均分级1.43±0.94对1.24±0.75，p = 0.058）。两种方法在AR评估中的相关性尚可（r = 0.70，p = 0.0001），一致率为59%。对于MR和AR分级，未发现瓣膜反流严重程度与术前TTE和预充泵TEE之间的血压差异有显著相关性。在17%的病例中，识别严重二尖瓣或主动脉瓣反流的差异可能会影响患者的管理。
TTE和预充泵TEE在MR和AR评估中一致性一般。心脏病专家、心脏外科医生和麻醉医生在使用预充泵TEE指导术中决策时必须意识到这些方法之间的差异。
