使用16排多层螺旋计算机断层扫描评估风湿性二尖瓣狭窄患者的二尖瓣平面面积
Assessment of planimetric mitral valve area using 16-row multidetector computed tomography in patients with rheumatic mitral stenosis.
作者信息
Uçar Ozgül, Vural Murat, Cetfïn Zehra, Gökaslan Serkan, Gürsoy Tugba, Paşaoğlu Lale, Koparal Suha, Aydoğlu Sinan
机构信息
Department of Cardiology, Ankara Numune Education and Research Hospital, Sihhiye, Ankara, Turkey.
出版信息
J Heart Valve Dis. 2011 Jan;20(1):13-7.
BACKGROUND AND AIM OF THE STUDY
Transthoracic two-dimensional echocardiography (TTE) is currently the 'gold standard' for the evaluation of rheumatic mitral valve disease. Multidetector computed tomography (MDCT) is a promising technique for the evaluation of heart valves. The study aim was to evaluate the planimetry of the mitral valve area (MVA) with 16-row MDCT in comparison with TTE, in patients with rheumatic mitral stenosis.
METHODS
Twenty-six patients (18 females, eight males; mean age 41.7 +/- 8.7 years) with rheumatic mitral valve disease, who had been referred for 16-row MDCT for various indications, such as evaluation of the coronary arteries, assessment of pulmonary vein anatomy before catheter ablation of paroxysmal atrial fibrillation, suspicion of aortic dissection or pulmonary embolism, were recruited. All patients were in sinus rhythm. The MDCT acquisition was performed using a 16-row scanner. Echocardiographic planimetry of MVA was performed in the standard parasternal short-axis view within one week.
RESULTS
Planimetry of the MVA with MDCT did not differ from that with TTE (1.88 +/- 0.46 cm2 versus 1.83 +/- 0.50 cm2, p = 0.242), and there was an excellent correlation between two techniques (r = 0.923, p < 0.0001). Seven patients had calcific mitral valves (mean calcium score 216.8 +/- 783.8 Agatston units). In these patients, MVA measured by MDCT was 1.73 +/- 0.39 cm2 and by TTE planimetry was 1.72 +/- 0.54 cm2 (p = 0.866; r = 0.963, p = 0.0005). When using the pressure half-time (PHT) method, the MVA was obtained in 24 of the 26 patients. MVA by PHT did not differ from the MVA calculated by TTE planimetry, nor from that obtained with MDCT planimetry (1.79 +/- 0.46 cm2 versus 1.81 +/- 0.51 cm2, p = 0.427 and 1.79 +/- 0.46 cm2 versus 1.86 +/- 0.48 cm2, p = 0.101, respectively). The correlation coefficient for the MDCT-derived MVA and PHT-derived MVA was 0.8969 (p < 0.0001). Although not statistically significant, in nine patients with moderate to severe mitral stenosis (MVA < 1.5 cm2), the MDCT tended to overestimate MVA compared to echo planimetry (1.35 +/- 0.19 cm2 versus 1.28 +/- 0.21 cm2, p = 0.059).
CONCLUSION
MDCT enabled accurate planimetry of the MVA in patients with rheumatic mitral stenosis, in comparison with TTE.
研究背景与目的
经胸二维超声心动图（TTE）是目前评估风湿性二尖瓣疾病的“金标准”。多排螺旋计算机断层扫描（MDCT）是一种用于评估心脏瓣膜的有前景的技术。本研究旨在比较16排MDCT与TTE测量风湿性二尖瓣狭窄患者二尖瓣口面积（MVA）的平面测量法。
方法
招募了26例风湿性二尖瓣疾病患者（18例女性，8例男性；平均年龄41.7±8.7岁），这些患者因各种适应证接受16排MDCT检查，如评估冠状动脉、阵发性房颤导管消融术前评估肺静脉解剖结构、怀疑主动脉夹层或肺栓塞等。所有患者均为窦性心律。使用16排扫描仪进行MDCT扫描。在一周内在标准胸骨旁短轴视图中进行MVA的超声心动图平面测量。
结果
MDCT测量的MVA与TTE测量的结果无差异（1.88±0.46 cm²对1.83±0.50 cm²，p = 0.242），两种技术之间具有良好的相关性（r = 0.923，p < 0.0001）。7例患者有钙化二尖瓣（平均钙化积分为216.8±783.8阿加斯顿单位）。在这些患者中，MDCT测量的MVA为1.73±0.39 cm²，TTE平面测量法测量的为1.72±0.54 cm²（p = 0.866；r = 0.963，p = 0.0005）。使用压力减半时间（PHT）法时，26例患者中有24例获得了MVA。PHT法测量的MVA与TTE平面测量法计算的MVA无差异，与MDCT平面测量法获得的结果也无差异（分别为1.79±0.46 cm²对1.81±0.51 cm²，p = 0.427；1.79±0.46 cm²对1.86±0.48 cm²，p = 0.101）。MDCT得出的MVA与PHT得出的MVA的相关系数为0.8969（p < 0.0001）。在9例中度至重度二尖瓣狭窄（MVA < 1.5 cm²）患者中，尽管无统计学意义，但与超声平面测量法相比，MDCT倾向于高估MVA（1.35±0.19 cm²对1.28±0.21 cm²，p = 0.059）。
结论
与TTE相比，MDCT能够准确测量风湿性二尖瓣狭窄患者的MVA。
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