Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
J Am Soc Echocardiogr. 2012 Apr;25(4):383-392.e4. doi: 10.1016/j.echo.2011.12.022. Epub 2012 Jan 21.
Appropriate patient selection for transcatheter pulmonary valve (TPV) replacement requires accurate evaluation of right ventricular (RV) performance. The aim of this study was to evaluate the reliability and accuracy of echocardiography for evaluating RV parameters in patients in the five-center Melody TPV trial.
Echocardiographic data were compared with cardiac magnetic resonance (CMR) and catheterization; interobserver comparisons were made using site and core laboratory data.
Doppler echocardiographic assessments of RV outflow tract obstruction and RV pressure showed excellent interobserver agreement; mean Doppler gradients were correlated most closely with gradients at catheterization (R = 0.66), and Doppler RV pressure estimates were correlated well with catheterization data (R = 0.58). Assessment of pulmonary regurgitation (PR) using a three-point severity scale showed good agreement with CMR-derived PR fraction (86%). The tricuspid annular Z score was highly reproducible but correlated weakly with CMR RV end-diastolic volume (R = 0.21). However, RV apical diastolic area was highly reproducible (R = 0.87) and had an excellent correlation with CMR RV end-diastolic volume (R = 0.78); all patients with indexed RV apical diastolic areas ≥30 cm(2)/m(2) had CMR RV end-diastolic volumes ≥160 mL/m(2). RV function using the fractional area change method showed a fair correlation with CMR RV ejection fraction (R = 0.48).
In patients with dysfunctional RV outflow tract conduits, echocardiography provided reproducible, accurate estimates of pressure overload and RV size. Echocardiographic assessment of PR correlated less closely with CMR PR fraction but showed good categorical agreement; assessment of RV function by these methods was suboptimal. Echocardiography alone may be a suitable screening test for some TPV replacement candidates; CMR may be indicated for TPV replacement decisions hinging on assessment of RV function.
经导管肺动脉瓣（TPV）置换术的适当患者选择需要准确评估右心室（RV）功能。本研究的目的是评估超声心动图在五中心 Melody TPV 试验中评估患者 RV 参数的可靠性和准确性。
将超声心动图数据与心脏磁共振（CMR）和导管插入术进行比较；使用现场和核心实验室数据进行观察者间比较。
RV 流出道梗阻和 RV 压力的多普勒超声心动图评估显示出良好的观察者间一致性；平均多普勒梯度与导管插入术的梯度相关性最好（R = 0.66），多普勒 RV 压力估计与导管插入术数据相关性良好（R = 0.58）。使用三点严重程度评分评估肺瓣反流（PR）与 CMR 衍生的 PR 分数具有良好的一致性（86%）。三尖瓣环 Z 评分高度可重复，但与 CMR RV 舒张末期容积相关性较弱（R = 0.21）。然而，RV 心尖舒张面积高度可重复（R = 0.87），与 CMR RV 舒张末期容积具有极好的相关性（R = 0.78）；所有 RV 心尖舒张面积指数≥30 cm²/m²的患者的 CMR RV 舒张末期容积均≥160 mL/m²。使用分数面积变化法的 RV 功能与 CMR RV 射血分数具有良好的相关性（R = 0.48）。
在 RV 流出道功能障碍的患者中，超声心动图提供了可重复、准确的压力超负荷和 RV 大小估计。PR 的超声心动图评估与 CMR PR 分数相关性较差，但具有良好的分类一致性；这些方法对 RV 功能的评估效果不理想。超声心动图本身可能是某些 TPV 置换候选者的合适筛选试验；对于依赖 RV 功能评估的 TPV 置换决策，可能需要进行 CMR。
