Lee Ming-Ming, Salahuddin Ayesha, Garcia Mario J, Spevack Daniel M
Department of Medicine, Rhode Island Hospital, Brown University, Providence, RI (M.M.L.).
Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.S., M.J.G., D.M.S.).
J Am Heart Assoc. 2015 Jun 12;4(6):e000781. doi: 10.1161/JAHA.113.000781.
No gold standard currently exists for quantification of mitral regurgitation (MR) severity. Classification by echocardiography is based on integrative criteria using color and spectral Doppler and anatomic measurements. We hypothesized that a simple Doppler left ventricular early inflow-outflow index (LVEIO), based on flow velocity into the left ventricle (LV) in diastole and ejected from the LV in systole, would add incrementally to current diagnostic criteria. LVEIO was calculated by dividing the mitral E-wave velocity by the LV outflow velocity time integral.
Transthoracic echocardiography reports from Montefiore Medical Center and its referring clinics from July 1, 2011, to December 31, 2011 (n=11 235) were reviewed. The MR severity reported by a cardiologist certified by the National Board of Echocardiography was used as a reference standard. Studies reporting moderate or severe MR (n=550) were reanalyzed to measure effective regurgitant orifice area by the proximal isovelocity surface area method, vena contracta width, MR jet area, and left-sided chamber volumes. LVEIO was 9.3±3.9, 7.0±3.2, and 4.2±1.7 among those with severe, moderate, and insignificant MR, respectively (ANOVA P<0.001). By receiver operating characteristic analysis, area under the curve for LVEIO was 0.92 for severe MR. Those with LVEIO ≥8 were likely to have severe MR (likelihood ratio 26.5), whereas those with LVEIO ≤4 were unlikely to have severe MR (likelihood ratio 0.11). LVEIO performed better in those with normal LV ejection fraction (≥50%) compared with those with reduced LV ejection fraction (<50%) (area under the curve 0.92 versus 0.80, P<0.001). By multivariate logistic regression analysis, LVEIO was independently associated with severe MR when compared with vena contracta width, MR jet area, and effective regurgitant orifice area measured by the proximal isovelocity surface area method.
LVEIO is a simple-to-use echocardiographic parameter that accurately identifies severe MR, particularly in patients with normal LV ejection fraction.
目前尚无用于量化二尖瓣反流（MR）严重程度的金标准。超声心动图分类基于使用彩色和频谱多普勒以及解剖学测量的综合标准。我们假设一个简单的多普勒左心室早期流入-流出指数（LVEIO），基于舒张期流入左心室（LV）和收缩期从左心室射出的血流速度，将对当前诊断标准有额外补充作用。LVEIO通过将二尖瓣E波速度除以左心室流出速度时间积分来计算。
回顾了蒙特菲奥里医疗中心及其转诊诊所2011年7月1日至2011年12月31日的经胸超声心动图报告（n = 11235）。由美国国家超声心动图委员会认证的心脏病专家报告的MR严重程度用作参考标准。对报告为中度或重度MR的研究（n = 550）进行重新分析，以通过近端等速表面积法测量有效反流口面积、反流束缩流宽度、MR射流面积和左侧心腔容积。重度、中度和轻度MR患者的LVEIO分别为9.3±3.9、7.0±3.2和4.2±1.7（方差分析P<0.001）。通过受试者工作特征分析，重度MR时LVEIO的曲线下面积为0.92。LVEIO≥8的患者很可能患有重度MR（似然比26.5），而LVEIO≤4的患者不太可能患有重度MR（似然比0.11）。与左心室射血分数降低（<50%）的患者相比，LVEIO在左心室射血分数正常（≥50%）的患者中表现更好（曲线下面积0.92对0.80，P<0.001）。通过多变量逻辑回归分析，与反流束缩流宽度、MR射流面积和通过近端等速表面积法测量的有效反流口面积相比，LVEIO与重度MR独立相关。
LVEIO是一个易于使用的超声心动图参数，可准确识别重度MR，尤其是在左心室射血分数正常的患者中。
