de Groot-de Laat Lotte E, Ren Ben, McGhie Jacky, Oei Frans B S, Strachinaru Mihai, Kirschbaum Sharon W M, Akin Sakir, Kievit Chris M, Bogers Ad J J C, Geleijnse Marcel L
Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Room BA 302, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
Department of Cardiothoracic Surgery, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
Int J Cardiovasc Imaging. 2016 Aug;32(8):1171-7. doi: 10.1007/s10554-016-0895-z. Epub 2016 May 11.
Contradiction exists on the incremental value of two-dimensional (2D) and 3D transoesophageal echocardiography (TOE) over 2D transthoracic echocardiography (TTE) for the detection of mitral valve (MV) prolapse in readers with different echocardiographic experience. Twenty patients and five healthy persons were retrospectively identified who had undergone 2D-TTE, 2D-TOE and 3D-TOE. Fifteen (75 %) patients had surgical evidence of prolapse of the posterior MV leaflet and five patients (25 %) had a dilated MV annulus without prolapse. Three reader groups with different echocardiographic expertise (novice, trainees, cardiologists) scored thus in total 675 posterior scallops. Overall there was an improvement in agreement and Kappa values from novice to trainees to cardiologists. Diagnostic accuracies of 2D-TOE were higher than those of 2D-TTE mainly in novice readers. The incremental value of 3D-TOE over 2D-TOE was mainly seen in specificities. Time to diagnosis was dramatically reduced from 2D to 3D-TEE in all reader groups (all P < 0.001). 3D-TOE also improved the agreement (+12 to +16 %) and Kappa values (+0.14 to +0.21) in all reader groups for the exact description of P2 prolapse. Differences between readers with variable experience in determining the precise localization and extent of the prolapsing posterior MV scallops exist in particular in 2D-TTE analysis. 3D-TOE analysis was extremely fast compared to the 2D analysis methods and showed the best diagnostic accuracy (mainly driven by specificity) with identification of P1 and P3 prolapse still improving from novice to trainees to cardiologists and provided optimal description of P2 prolapse extent.
对于不同超声心动图经验的读者而言，在检测二尖瓣脱垂方面，二维（2D）和三维经食管超声心动图（TOE）相较于二维经胸超声心动图（TTE）的增量价值存在矛盾。回顾性纳入了20例患者和5名健康人，他们均接受了2D-TTE、2D-TOE和3D-TOE检查。15例（75%）患者有二尖瓣后叶脱垂的手术证据，5例（25%）患者二尖瓣环扩张但无脱垂。三个具有不同超声心动图专业水平的读者组（新手、实习生、心脏病专家）对总共675个后叶扇形区进行了评分。总体而言，从新手到实习生再到心脏病专家，一致性和Kappa值均有所提高。2D-TOE的诊断准确性主要在新手读者中高于2D-TTE。3D-TOE相较于2D-TOE的增量价值主要体现在特异性方面。在所有读者组中，从2D到3D-TEE的诊断时间均显著缩短（所有P<0.001）。3D-TOE还提高了所有读者组在精确描述P2脱垂方面的一致性（提高12%至16%）和Kappa值（提高0.14至0.21）。在确定二尖瓣后叶脱垂扇形区的精确位置和范围时，不同经验的读者之间存在差异，尤其是在2D-TTE分析中。与2D分析方法相比，3D-TOE分析速度极快，显示出最佳的诊断准确性（主要由特异性驱动），在识别P1和P3脱垂方面，从新手到实习生再到心脏病专家仍在不断提高，并且能够对P2脱垂范围进行最佳描述。
