Masuyama T, Kitabatake A, Kodama K, Uematsu M, Nakatani S, Kamada T
Cardiovascular Division, Osaka Police Hospital, Japan.
Am Heart J. 1989 Jan;117(1):133-9. doi: 10.1016/0002-8703(89)90667-4.
The accuracy of pulsed and continuous wave (CW) Doppler methods for evaluating aortic regurgitation (AR) was compared in patients with and without mitral stenosis (MS), with aortic root angiography as a gold standard. AR was diagnosed with pulsed Doppler echocardiography, by the detection of broad frequency spectral patterns in the isovolumic relaxation time. If these indications were present, AR was graded by examining the extent of diastolic turbulence in the left ventricular cavity (flow mapping method). With CW Doppler echocardiography, AR was diagnosed by the detection of a peak velocity of greater than 2 m/s; if this velocity was attained, AR was graded by measuring the time from the peak velocity to half the peak velocity (half-time method). The angiographic grade corresponded to that determined by the pulsed and CW Doppler methods in 37 and 37 of 46 patients without MS, respectively. Angiographic grade corresponded to the grade determined by the pulsed and CW Doppler methods in 13 and 17 of the 23 patients with MS, respectively. Eight of 10 discrepancies between pulsed Doppler and angiographic grades were due to overestimation of AR by the flow mapping method, apparently because the transmitral jet produces diastolic turbulence in the left ventricular cavity independent of AR. On the other hand, three of six discrepancies between CW Doppler and angiographic grades were due to the incapability of detecting signals of AR by CW Doppler echocardiography. Thus both the pulsed and the CW Doppler methods are useful to evaluate AR in patients without MS. In patients with MS, however, AR is most accurately diagnosed by the detection of AR signals in the isovolumic relaxation time by pulsed Doppler echocardiography, and the degree of AR is more accurately assessed by the CW Doppler half-time method.
以主动脉根部血管造影作为金标准，比较了脉冲多普勒和连续波（CW）多普勒方法评估有或无二尖瓣狭窄（MS）患者主动脉瓣反流（AR）的准确性。通过检测等容舒张期的宽频带频谱模式，用脉冲多普勒超声心动图诊断AR。如果出现这些指征，则通过检查左心室腔内舒张期湍流的范围（血流图法）对AR进行分级。对于CW多普勒超声心动图，通过检测峰值速度大于2m/s来诊断AR；如果达到该速度，则通过测量从峰值速度到峰值速度一半的时间（半值时间法）对AR进行分级。在46例无MS的患者中，血管造影分级分别与脉冲多普勒和CW多普勒方法确定的分级在37例患者中相符。在23例有MS的患者中，血管造影分级分别与脉冲多普勒和CW多普勒方法确定的分级在13例和17例患者中相符。脉冲多普勒与血管造影分级之间的10个差异中有8个是由于血流图法高估了AR，显然是因为二尖瓣反流束在左心室腔内产生了与AR无关的舒张期湍流。另一方面，CW多普勒与血管造影分级之间的6个差异中有3个是由于CW多普勒超声心动图无法检测到AR信号。因此，脉冲多普勒和CW多普勒方法都有助于评估无MS患者的AR。然而，对于有MS的患者，通过脉冲多普勒超声心动图检测等容舒张期的AR信号能最准确地诊断AR，而通过CW多普勒半值时间法能更准确地评估AR的程度。
