Department of Cardiology, Leiden University Medical Center, the Netherlands.
Ann Thorac Surg. 2011 Jan;91(1):113-21. doi: 10.1016/j.athoracsur.2010.08.048.
Surgical ventricular reconstruction has been proposed as a treatment option in heart failure patients with left ventricular (LV) aneurysm. The feasibility of this procedure has some limitations, and extensive preoperative evaluation is necessary to give the correct indication. For this purpose, magnetic resonance imaging (MRI) is currently considered the gold standard, providing accurate quantification of LV shape, size, and global and regional function together with the assessment of myocardial scar and mitral regurgitation severity. The aim of this study was to evaluate the accuracy of real-time three-dimensional echocardiography (RT3DE) as a potential alternative to MRI for this evaluation.
A total of 52 patients with ischemic cardiomyopathy and LV aneurysm underwent a comprehensive analysis with two-dimensional echocardiography, RT3DE, and MRI.
Excellent correlation (r=0.97, p<0.001) and agreement were found between RT3DE and MRI for quantification of LV volumes, ejection fraction, and sphericity index; in a segment-to-segment comparison, RT3DE was shown to be accurate also for the analysis of wall motion abnormalities (k=0.62) and LV regional thickness (k=0.56) as a marker of myocardial scar. In contrast, two-dimensional echocardiography significantly underestimated these variables. Furthermore, mitral regurgitant volume assessed by RT3DE showed excellent correlation (r=0.93) with regurgitant volume measured by MRI, without significant bias (=-0.7 mL/beat).
In the management of heart failure patients with LV aneurysm, RT3DE provides an accurate and comprehensive assessment, including quantification of LV size, shape, global systolic function, regional wall motion, and myocardial scar together with precise evaluation of the severity of mitral regurgitation.
外科心室重构已被提议作为左心室（LV）瘤患者心力衰竭的治疗选择。该手术的可行性存在一些局限性，需要进行广泛的术前评估才能给出正确的指示。为此，磁共振成像（MRI）目前被认为是金标准，它可以提供 LV 形状、大小以及整体和局部功能的准确量化，同时评估心肌瘢痕和二尖瓣反流的严重程度。本研究旨在评估实时三维超声心动图（RT3DE）作为替代 MRI 进行评估的潜在准确性。
共 52 例缺血性心肌病伴 LV 瘤患者接受了二维超声心动图、RT3DE 和 MRI 的综合分析。
RT3DE 与 MRI 之间在 LV 容积、射血分数和球形指数的定量方面存在极好的相关性（r=0.97，p<0.001）和一致性；在节段间比较中，RT3DE 也显示出分析壁运动异常（k=0.62）和 LV 局部厚度（k=0.56）作为心肌瘢痕标志物的准确性，后者作为心肌瘢痕的标志物。相比之下，二维超声心动图显著低估了这些变量。此外，RT3DE 评估的二尖瓣反流量与 MRI 测量的反流量具有极好的相关性（r=0.93），且无显著偏差（=-0.7 mL/beat）。
在 LV 瘤心力衰竭患者的管理中，RT3DE 提供了一种准确全面的评估，包括 LV 大小、形状、整体收缩功能、局部壁运动和心肌瘢痕的量化，以及二尖瓣反流严重程度的精确评估。
