Luis Sushil Allen, Blauwet Lori A, Samardhi Himabindu, West Cathy, Mehta Ramila A, Luis Chris R, Scalia Gregory M, Miller Fletcher A, Burstow Darryl J
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2017 Oct 15;120(8):1373-1380. doi: 10.1016/j.amjcard.2017.07.026. Epub 2017 Jul 25.
This study aimed to investigate the utility of transthoracic echocardiographic (TTE) Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define optimal cut-off values for identification of such dysfunction by valve type. In total, 971 TTE studies (647 mechanical prostheses; 324 bioprostheses) were compared with transesophageal echocardiography for evaluation of mitral prosthesis function. Among all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral of MVP to that of left ventricular outflow tract; odds ratio [OR] 10.34, 95% confidence interval [95% CI] 6.43 to 16.61, p<0.001), E velocity (OR 3.23, 95% CI 1.61 to 6.47, p<0.001), and mean gradient (OR 1.13, 95% CI 1.02 to 1.25, p=0.02) provided good discrimination of clinically normal and clinically abnormal prostheses. Optimal cut-off values by receiver operating characteristic analysis for differentiating clinically normal and abnormal prostheses varied by prosthesis type. Combining MVP ratio and E velocity improved specificity (92%) and positive predictive value (65%) compared with either parameter alone, with minimal decline in negative predictive value (92%). Pressure halftime (OR 0.99, 95% CI 0.98 to 1.00, p=0.04) did not differentiate between clinically normal and clinically abnormal prostheses but was useful in discriminating obstructed from normal and regurgitant prostheses. In conclusion, cut-off values for TTE-derived Doppler parameters of MVP function were specific to prosthesis type and carried high sensitivity and specificity for identifying prosthetic valve dysfunction. MVP ratio was the best predictor of prosthetic dysfunction and, combined with E velocity, provided a useful parameter for determining likelihood of dysfunction and need for further assessment.
本研究旨在探讨经胸超声心动图（TTE）多普勒衍生参数在检测二尖瓣人工瓣膜功能障碍中的效用，并按瓣膜类型确定识别此类功能障碍的最佳临界值。总共971例TTE检查（647例机械瓣膜；324例生物瓣膜）与经食管超声心动图进行比较，以评估二尖瓣人工瓣膜功能。在所有人工瓣膜中，二尖瓣人工瓣膜（MVP）比率（MVP时间速度积分与左心室流出道时间速度积分之比；优势比[OR]10.34，95%置信区间[95%CI]6.43至16.61，p<0.001）、E速度（OR 3.23，95%CI 1.61至6.47，p<0.001）和平均压差（OR 1.13，95%CI 1.02至1.25，p=0.02）对临床正常和临床异常人工瓣膜具有良好的鉴别能力。通过受试者操作特征分析确定的区分临床正常和异常人工瓣膜的最佳临界值因人工瓣膜类型而异。与单独使用任一参数相比，将MVP比率和E速度相结合可提高特异性（92%）和阳性预测值（65%），阴性预测值仅有轻微下降（92%）。压力减半时间（OR 0.99，95%CI 0.98至1.00，p=0.04）不能区分临床正常和临床异常人工瓣膜，但有助于区分梗阻性与正常及反流性人工瓣膜。总之，TTE衍生的MVP功能多普勒参数的临界值因人工瓣膜类型而异，对识别人工瓣膜功能障碍具有高敏感性和特异性。MVP比率是人工瓣膜功能障碍的最佳预测指标，与E速度相结合，为确定功能障碍的可能性和进一步评估的必要性提供了一个有用的参数。
