经导管主动脉瓣置换术后瓣周主动脉瓣反流的三维超声心动图评估。

Three-dimensional echocardiography in paravalvular aortic regurgitation assessment after transcatheter aortic valve implantation.

机构信息

Cardiovascular Institute, Hospital Clínico San Carlos, Complutense University, Madrid, Spain.

出版信息

J Am Soc Echocardiogr. 2012 Jan;25(1):47-55. doi: 10.1016/j.echo.2011.08.019. Epub 2011 Sep 29.

DOI:10.1016/j.echo.2011.08.019

PMID:21962448

Abstract

BACKGROUND

Paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is common, but the evaluation of its severity by two-dimensional (2D) transthoracic echocardiography (TTE) presents several constrains. The aim of this study was to assess the usefulness of a new methodology, using three-dimensional (3D) TTE, for better assessment of paravalvular AR after TAVI.

METHODS

Two-dimensional and 3D TTE was performed in 72 patients, 5 months after TAVI, using the X5-1 PureWave microbeamforming xMATRIX probe. The position and severity of the paravalvular AR jets were described using 2D and 3D TTE, and a model was designed for paravalvular AR systematic location description. Vena contracta width was measured using 2D transthoracic echocardiographic views, and the planimetry of the vena contracta was assessed after the perfect alignment plane was obtained using the multiplanar 3D transthoracic echocardiographic reconstruction tool. AR volume was calculated as the difference between 3D TTE-derived total left ventricular stroke volume and right ventricular stroke volume estimated using 2D TTE. Diagnostic efficiency for moderate AR was assessed using receiver operating characteristic curve analysis.

RESULTS

Forty-three patients (57.4%) presented with AR; 10 (13.3%) had central AR, and 33 (44.0%) had paravalvular AR jets. Vena contracta widths were similar between patients with moderate and mild AR (2.1 ± 0.53 vs 1.9 ± 0.16 mm, P = .16), but vena contracta planimetry was larger in patients with moderate AR than in those with mild AR (0.30 ± 0.12 vs 0.09 ± 0.07 cm(2), P = .001). Vena contracta planimetry on 3D TTE was better correlated with AR volume than vena contracta width on 2D TTE (Kendall's τ = 0.82 [P < .001] vs 0.66 [P < .001]). The areas under the receiver operating characteristic curves were 0.96 for vena contracta planimetry and 0.35 for vena contracta width.

CONCLUSIONS

This study proposes an alternative methodology for paravalvular AR assessment after TAVI. Using vena contracta planimetry on 3D TTE, an accurate methodology for paravalvular AR jet evaluation and moderate AR classification is described.

摘要

背景

经导管主动脉瓣置换术（TAVI）后发生瓣周主动脉瓣反流（AR）较为常见，但二维（2D）经胸超声心动图（TTE）评估其严重程度存在诸多限制。本研究旨在评估一种新的三维（3D）TTE 方法在评估 TAVI 后瓣周 AR 中的应用价值。

方法

72 例患者在 TAVI 后 5 个月接受 2D 和 3D TTE 检查，使用 X5-1 PureWave 微波束形成 xMATRIX 探头。使用 2D 和 3D TTE 描述瓣周 AR 射流的位置和严重程度，并设计了一种瓣周 AR 系统定位描述模型。使用 2D 经胸超声心动图切面测量收缩期瓣口最小直径（vena contracta width，VCW），通过多平面 3D 经胸超声心动图重建工具获得理想的平面后，评估 VCW 的平面测量。AR 容量通过 3D TTE 计算的左心室总搏出量与 2D TTE 估计的右心室搏出量之间的差值计算得出。使用受试者工作特征曲线分析评估中度 AR 的诊断效率。

结果

43 例患者（57.4%）存在 AR；10 例（13.3%）为中心 AR，33 例（44.0%）为瓣周 AR 射流。中度 AR 和轻度 AR 患者的 VCW 宽度相似（2.1 ± 0.53 比 1.9 ± 0.16mm，P =.16），但中度 AR 患者的 VCW 平面测量值大于轻度 AR 患者（0.30 ± 0.12 比 0.09 ± 0.07cm2，P =.001）。3D TTE 上的 VCW 平面测量值与 AR 容量的相关性优于 2D TTE 上的 VCW 宽度（Kendall's τ = 0.82[P<0.001]比 0.66[P<0.001]）。VCW 平面测量值的受试者工作特征曲线下面积为 0.96，VCW 宽度为 0.35。