Ionac A, Mornoş C, Feier H, Cozma D, Petrescu L, Popescu I, Ionescu G, Cocora M, Gaspar M, Drăgulescu S I
IInd Cardiology Clinic, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania.
Chirurgia (Bucur). 2011 Mar-Apr;106(2):211-7.
In this study we aimed to evaluate the three-dimensional (3D) transthoracic echocardiography (TTE) in the assessment of cardiac valve morphology.
Bidimensional (2D) and real-time 3D TTE was performed in 104 patients consecutive with cardiac catheterisation, prior to valve surgery. Using surgical findings as the gold standard, 2D and 3D TTE were compared for adequate recognition and accurate detection of morphology. A scoring protocol was used for recognition of the valvular segments (0= inadequate, 1 = adequate).
Adequate echographic visualization of the valve segments was more frequently obtained by 3D than 2D TTE imaging (731/770 by 3D TTE vs. 693/770 by 2D TTE, p < 0.01). The valve leaflets segments were more clearly identified by 3D TTE rather than by 2D TTE (502/531 vs. 471/531, p <0.01). The assessment of commissures was similar by both methods (229/239 vs. 222/239, p=0.09). Total 3D TTE scores for mitral and aortic valves were significantly better than 2D ITE scores (mean score 12.91+/-1.62 by 3D vs 11.58+/-1.02 by 2D, p=0.02). This superiority of 3D TTE was irrespective of rhythm (p <0.05 for both sinus rhythm and atrial fibrillation). Using surgical classification of valvular disease as gold standard, the sensibility and specificity were 91% and 84 % for 3D TTE, and 85% and 77% for 2D TTE, respectively.
Real-time 3D was superior to 2D TTE forthe accurate localization and identification of valvular pathology, irrespective of heart rhythm.
在本研究中，我们旨在评估三维（3D）经胸超声心动图（TTE）在评估心脏瓣膜形态方面的作用。
在104例连续接受心脏导管检查且即将接受瓣膜手术的患者中进行二维（2D）和实时3D TTE检查。以手术结果作为金标准，比较2D和3D TTE对瓣膜形态的充分识别和准确检测情况。采用评分方案对瓣膜节段进行识别（0 = 不充分，1 = 充分）。
与2D TTE成像相比，3D TTE更常获得瓣膜节段的充分超声可视化（3D TTE为731/770，2D TTE为693/770，p < 0.01）。3D TTE比2D TTE更能清晰地识别瓣膜小叶节段（502/531对471/531，p < 0.01）。两种方法对瓣叶联合的评估相似（229/239对222/239，p = 0.09）。二尖瓣和主动脉瓣的3D TTE总评分显著优于2D TTE评分（3D平均评分为12.91±1.62，2D为11.58±1.02，p = 0.02）。3D TTE的这种优势与心律无关（窦性心律和心房颤动的p均< 0.05）。以瓣膜疾病的手术分类作为金标准，3D TTE的敏感性和特异性分别为91%和84%，2D TTE分别为85%和77%。
无论心律如何，实时3D在准确定位和识别瓣膜病变方面均优于2D TTE。
