From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.).
Circ Cardiovasc Imaging. 2014 May;7(3):535-44. doi: 10.1161/CIRCIMAGING.113.001457. Epub 2014 Apr 3.
The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography-based MR quantification has well-documented limitations.
We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-color Doppler echocardiography in 211 (95.5%) patients. The quantitative differences between the MR volumes obtained by 2D- and 3D-proximal isovelocity surface area (PISA) were analyzed in various MR subgroups. In the validation cohort (n=52), MR volume obtained by 3D-PISA showed a better agreement with phase-contrast cardiac MRI than 2D-PISA (r=0.97 versus 0.84). In all 211 patients, 2D-PISA underestimated the MR volume when compared with 3D-PISA (52.4±19.6 versus 59.5±25.6 mL; P=0.005). A total of 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having nonsevere MR. In the subgroup analysis, the MR severity (odds ratio, 6.96; 95% confidence interval, 3.04-15.94; P<0.001) and having an asymmetrical orifice (odds ratio, 11.48; 95% confidence interval, 3.72-35.4; P<0.001), and an eccentric jet (odds ratio, 3.82; 95% confidence interval, 1.27-11.48; P=0.017) were predictors of significant difference in MR volume (>15 mL) between 2D- and 3D-PISA methods.
Quantification of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantification by 2D-PISA significantly underestimated MR volume with severe, eccentric MR with an asymmetrical orifice. This article demonstrates that 3D-color Doppler echocardiography could be used as a valuable tool to confirm treatment strategy in patients with significant MR.
本研究旨在探讨三维彩色多普勒超声心动图在二尖瓣反流（MR）定量评估中的差异效应。二维彩色多普勒超声心动图的 MR 定量评估有明确的局限性。
我们连续纳入 221 例 MR 患者。211 例（95.5%）患者通过二维和三维彩色多普勒超声心动图获得了足够的图像质量。分析了各种 MR 亚组中二维和三维近端等速表面积（PISA）测量的 MR 容积的定量差异。在验证队列（n=52）中，3D-PISA 测量的 MR 容积与相位对比心脏 MRI 的相关性优于二维 PISA（r=0.97 比 0.84）。在所有 211 例患者中，与 3D-PISA 相比，二维 PISA 低估了 MR 容积（52.4±19.6 比 59.5±25.6 mL；P=0.005）。基于 3D-PISA 诊断为重度 MR 的患者中，有 33.3%的患者被二维 PISA 错误评估为非重度 MR。在亚组分析中，MR 严重程度（比值比，6.96；95%置信区间，3.04-15.94；P<0.001）、瓣口不对称（比值比，11.48；95%置信区间，3.72-35.4；P<0.001）和偏心射流（比值比，3.82；95%置信区间，1.27-11.48；P=0.017）是二维和三维 PISA 方法测量的 MR 容积（>15 mL）差异的预测因素。
3D-PISA 方法测量 MR 具有临床可行性，比当前的二维 PISA 方法更准确。二维 PISA 方法对严重、偏心、瓣口不对称的 MR 进行 MR 容积定量评估时，会显著低估 MR 容积。本文表明，三维彩色多普勒超声心动图可作为评估重度 MR 患者治疗策略的有价值的工具。
