Fukuda Shota, Lever Harry M, Stewart William J, Tran Hung, Song Jong-Min, Shin Mi-Seong, Greenberg Neil L, Wada Nozomi, Matsumura Yoshiki, Toyono Manatomo, Smedira Nicholas G, Thomas James D, Shiota Takahiro
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Am Soc Echocardiogr. 2008 Jul;21(7):789-95. doi: 10.1016/j.echo.2008.01.012. Epub 2008 Mar 6.
Earlier studies demonstrated the ability of real-time 3-dimensional (3D) echocardiography (3DE) to measure left ventricular outflow tract (LVOT) area (A(LVOT)) in patients with hypertrophic cardiomyopathy (HCM). However, its clinical value is unknown.
We sought to investigate the feasibility and accuracy of real-time 3DE-derived A(LVOT) to diagnose significant LVOT obstruction in a large number of patients with HCM.
A total of 162 patients with HCM had 3DE by using a volumetric system. The smallest A(LVOT) during systole was determined by moving a 2-dimensional plane in 3D space. The pressure gradient across LVOT was assessed by continuous wave Doppler method. Provocation was performed in patients without significant LVOT obstruction (pressure gradient across LVOT < 50 mm Hg) at rest.
Twenty (12%) patients with poor image quality of 3DE were excluded; 16 (28%) patients with a volumetric system, but only 4 (4%) patients with commercial equipment (P < .001). In the remaining 142 patients, A(LVOT) inversely correlated with pressure gradient across LVOT both at rest (r = 0.82, P < .001) and after provocation (r = 0.60, P < .001). The value of A(LVOT) less than 0.85 cm(2) and less than 2.0 cm(2) predicted resting and provokable LVOT obstruction with sensitivity of 87% and 81%, and specificity of 77% and 90%, respectively.
Real-time 3DE measurement of A(LVOT) was successful in diagnosing and quantifying LVOT obstruction at rest and after provocation in a large number of patients with HCM.
早期研究表明，实时三维（3D）超声心动图（3DE）能够测量肥厚型心肌病（HCM）患者的左心室流出道（LVOT）面积（A(LVOT)）。然而，其临床价值尚不清楚。
我们旨在研究实时3DE衍生的A(LVOT)在大量HCM患者中诊断显著LVOT梗阻的可行性和准确性。
共有162例HCM患者使用容积系统进行了3DE检查。通过在三维空间中移动二维平面来确定收缩期最小的A(LVOT)。采用连续波多普勒法评估LVOT两端的压力阶差。对静息时无显著LVOT梗阻（LVOT两端压力阶差<50 mmHg）的患者进行激发试验。
排除20例（12%）3DE图像质量差的患者；使用容积系统的患者中有16例（28%），但使用商用设备的患者仅4例（4%）（P <.001）。在其余142例患者中，A(LVOT)与静息时（r = 0.82，P <.001）和激发后（r = 0.60，P <.001）LVOT两端压力阶差呈负相关。A(LVOT)小于0.85 cm²和小于2.0 cm²分别预测静息和激发时LVOT梗阻，敏感性分别为87%和81%，特异性分别为77%和90%。
实时3DE测量A(LVOT)成功地在大量HCM患者中诊断和量化了静息和激发时的LVOT梗阻。
