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法洛四联症修复术后:右心室容积与左心室容积之比作为右心室扩张的标志物。

Repaired tetralogy of Fallot: ratio of right ventricular volume to left ventricular volume as a marker of right ventricular dilatation.

机构信息

Department of Coronary Artery Disease and Structural Heart Diseases, Cardiac Magnetic Resonance Unit, Institute of Cardiology, ul Alpejska 42, 04-628 Warsaw, Poland.

出版信息

Radiology. 2012 Oct;265(1):78-86. doi: 10.1148/radiol.12120051. Epub 2012 Jul 6.

Abstract

PURPOSE

To compare indexed right ventricular (RV) end-diastolic volume (RVEDVi) and the ratio of RV volume to left ventricular (LV) volume (RV/LV ratio) in prediction of significant pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair and to assess sex differences in the RV/LV ratio.

MATERIALS AND METHODS

The ethics committee approved this retrospective single-center study, and patients or their parents or guardians signed written informed consent. RVEDVi, RV/LV ratio, and PR were measured with the use of magnetic resonance imaging in 155 consecutive patients with repaired TOF (mean age, 29.2 years±10.9 [standard deviation]; 98 [63.2%] male and 57 [36.8%] female patients). PR fraction of 20% or greater was considered significant. The capability of the RVEDVi and that of the RV/LV ratio for prediction of significant PR were compared by using logistic regression analysis and receiver operating characteristic curve analysis.

RESULTS

RVEDVi was significantly higher in male (162.8 mL/m2±50.4) than in female (138.2 mL/m2±37.5) patients (P=.001). Conversely, the RV/LV ratio was similar in both sexes (1.82±0.56 [male] vs 1.69±0.46 [female], P=.13) both in the entire cohort and after excluding patients with significant (≥30 mm Hg) RV outflow tract gradient and/or other residual hemodynamic abnormalities (P=.63). Receiver operating characteristic analysis revealed better discrimination of significant (≥20%) from insignificant (<20%) PR with the use of the RV/LV ratio than with RVEDVi (area under the receiver operating characteristic curve, 0.937 [model 4] vs 0.849 [model 1], P=.01). In multivariate analysis, the only independent predictor of PR fraction was the RV/LV ratio.

CONCLUSION

The RV/LV ratio is more accurate than the RVEDVi in differentiation of significant from insignificant PR. After TOF repair, female and male patients have similar RV/LV ratios despite significant differences in RVEDVi between the sexes.

摘要

目的

比较索引右心室(RV)舒张末期容积(RVEDVi)和 RV 与左心室(LV)容积比(RV/LV 比)在法洛四联症(TOF)修复后预测重度肺动脉瓣反流(PR)中的作用,并评估 RV/LV 比的性别差异。

材料和方法

该研究为回顾性单中心研究,经伦理委员会批准,患者或其父母或监护人签署了书面知情同意书。使用磁共振成像测量 155 例连续修复的 TOF 患者的 RVEDVi、RV/LV 比和 PR(平均年龄 29.2 岁±10.9[标准差];男性 98 例[63.2%],女性 57 例[36.8%])。PR 分数≥20% 被认为是显著的。使用逻辑回归分析和接收者操作特征曲线分析比较了 RVEDVi 和 RV/LV 比预测重度 PR 的能力。

结果

男性(162.8 毫升/平方米±50.4)RVEDVi 明显高于女性(138.2 毫升/平方米±37.5)(P=.001)。相反,在整个队列和排除有显著(≥30mmHg)RV 流出道梯度和/或其他残余血流动力学异常的患者后,RV/LV 比在男女两性均相似(1.82±0.56[男性]与 1.69±0.46[女性],P=.13)(P=.63)。接收者操作特征分析显示,与 RVEDVi 相比,使用 RV/LV 比可更好地区分重度(≥20%)与轻度(<20%)PR(接收者操作特征曲线下面积,0.937[模型 4]与 0.849[模型 1],P=.01)。多变量分析显示,PR 分数的唯一独立预测因子是 RV/LV 比。

结论

与 RVEDVi 相比,RV/LV 比在区分重度与轻度 PR 方面更准确。在 TOF 修复后,尽管男性和女性 RVEDVi 存在显著差异,但 RV/LV 比在两性之间相似。

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