Yoshida K, Yoshikawa J, Akasaka T, Shakudo M, Jyo Y, Takao S, Shiratori K, Okumachi F, Koizumi K, Kato H
Department of Cardiology, Kobe General Hospital.
J Cardiol. 1989 Mar;19(1):195-206.
To evaluate the clinical value of various Doppler techniques in detecting valvular regurgitation, we compared the sensitivity, timing and duration of regurgitation, and the peak velocity of regurgitant signals among conventional pulsed Doppler, color Doppler, continuous wave Doppler and HPRF Doppler echocardiography. 1. Sensitivity of Doppler techniques in detecting mitral regurgitation: Among fifty patients with mitral regurgitation confirmed by left ventriculography, mitral regurgitation was detected in 48 (96%) using color Doppler and pulsed Doppler echocardiography; in 41 (82%) by HPRF Doppler; and in 37 (74%) by continuous wave Doppler echocardiography. In 103 consecutive normal volunteers, mitral regurgitant signals were detected in 46 (45%) by color Doppler, in 39 (38%) by pulsed Doppler, in 16 (16%) by HPRF Doppler, and in 8 (8%) by continuous wave Doppler echocardiography. 2. Timing and duration of regurgitant signals: To assess the timing and duration of regurgitant signals, 43 patients with regurgitant signals of short duration during systole or diastole were studied using M-mode color Doppler echocardiography. Using the latter method, regurgitant signals throughout systole and the isovolumic relaxation period could be demonstrated in all but four patients who had regurgitant signals of short duration during systole, but suggesting mitral or tricuspid regurgitation. In all patients with regurgitant signals of short duration during diastole, aortic or pulmonary regurgitant signals throughout diastole could be demonstrated with M-mode color Doppler echocardiography. Thus, this technique is superior to conventional pulsed Doppler echocardiography for detecting accurate timing and duration of valvular regurgitation. 3. Peak velocity of regurgitant flow: To compare the peak velocity of regurgitant flow by continuous wave Doppler and by HPRF Doppler echocardiography, 20 patients with mitral regurgitation and 22 patients with tricuspid regurgitation were examined using the both methods. In patients with severe mitral regurgitation, the peak velocity detected by HPRF Doppler echocardiography correlated well (r = 0.96) with that detected by continuous wave Doppler echocardiography. However, in patients with mild mitral regurgitation, the peak velocity detected by HPRF Doppler echocardiography was higher than that detected by continuous wave Doppler echocardiography. In patients with severe tricuspid regurgitation, the peak velocity had a close correlation (r = 0.99) with the both techniques. In patients with mild tricuspid regurgitation, the peak velocity was higher by HPRF than by continuous wave Doppler echocardiography. In conclusion, color or pulsed Doppler echocardiography should be used for detecting valvular regurgitation. M-mode color Doppler echocardiography is superior to conventional pulsed Doppler echocardiography for detecting timing and duration of valvular regurgitation.(ABSTRACT TRUNCATED AT 400 WORDS)
为评估各种多普勒技术在检测瓣膜反流中的临床价值，我们比较了传统脉冲多普勒、彩色多普勒、连续波多普勒和高脉冲重复频率（HPRF）多普勒超声心动图在检测反流的敏感性、反流时间和持续时间以及反流信号的峰值速度。1. 多普勒技术检测二尖瓣反流的敏感性：在经左心室造影证实为二尖瓣反流的50例患者中，彩色多普勒和脉冲多普勒超声心动图检测到二尖瓣反流的有48例（96%）；高脉冲重复频率多普勒检测到的有41例（82%）；连续波多普勒超声心动图检测到的有37例（74%）。在103例连续正常志愿者中，彩色多普勒检测到二尖瓣反流信号的有46例（45%），脉冲多普勒检测到的有39例（38%），高脉冲重复频率多普勒检测到的有16例（16%），连续波多普勒超声心动图检测到的有8例（8%）。2. 反流信号的时间和持续时间：为评估反流信号的时间和持续时间，对43例在收缩期或舒张期有短持续时间反流信号的患者进行了M型彩色多普勒超声心动图研究。使用后一种方法，除4例在收缩期有短持续时间反流信号但提示二尖瓣或三尖瓣反流的患者外，所有患者在整个收缩期和等容舒张期的反流信号均可显示。在所有舒张期有短持续时间反流信号的患者中，M型彩色多普勒超声心动图可显示整个舒张期的主动脉或肺动脉反流信号。因此，该技术在检测瓣膜反流的准确时间和持续时间方面优于传统脉冲多普勒超声心动图。3. 反流血流的峰值速度：为比较连续波多普勒和高脉冲重复频率多普勒超声心动图检测反流血流的峰值速度，对20例二尖瓣反流患者和22例三尖瓣反流患者使用两种方法进行了检查。在重度二尖瓣反流患者中，高脉冲重复频率多普勒超声心动图检测到的峰值速度与连续波多普勒超声心动图检测到的峰值速度相关性良好（r = 0.96）。然而，在轻度二尖瓣反流患者中，高脉冲重复频率多普勒超声心动图检测到的峰值速度高于连续波多普勒超声心动图检测到的峰值速度。在重度三尖瓣反流患者中，峰值速度与两种技术均密切相关（r = 0.99）。在轻度三尖瓣反流患者中，高脉冲重复频率多普勒检测到的峰值速度高于连续波多普勒超声心动图检测到的峰值速度。总之，彩色或脉冲多普勒超声心动图应用于检测瓣膜反流。M型彩色多普勒超声心动图在检测瓣膜反流的时间和持续时间方面优于传统脉冲多普勒超声心动图。（摘要截短至400字）
