Centre Cardiothoracique de Monaco, 98000, Monaco.
Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Lille Nord de France, 59000 Lille, France.
Arch Cardiovasc Dis. 2018 Aug-Sep;111(8-9):507-517. doi: 10.1016/j.acvd.2017.10.008. Epub 2018 Mar 31.
Quantitative assessment of primary mitral regurgitation (MR) using left ventricular (LV) volumes obtained with three-dimensional transthoracic echocardiography (3D TTE) recently showed encouraging results. Nevertheless, 3D TTE is not incorporated into everyday practice, as current LV chamber quantification software products are time consuming.
To investigate the accuracy and reproducibility of new automated fast 3D TTE software (HeartModel; Philips Healthcare, Andover, MA, USA) for the quantification of LV volumes and MR severity in patients with isolated degenerative primary MR; and to compare regurgitant volume (RV) obtained with 3D TTE with a cardiac magnetic resonance (CMR) reference.
Fifty-three patients (37 men; mean age 64±12 years) with at least mild primary isolated MR, and having comprehensive 3D TTE and CMR studies within 24h, were eligible for inclusion. MR RV was calculated using the proximal isovelocity surface area (PISA) method and the volumetric method (total LV stroke volume minus aortic stroke volume) with either CMR or 3D TTE.
Inter- and intraobserver reproducibility of 3D TTE was excellent (coefficient of variation≤10%) for LV volumes. MR RV was similar using CMR and 3D TTE (57±23mL vs 56±28mL; P=0.22), but was significantly higher using the PISA method (69±30mL; P<0.05 compared with CMR and 3D TTE). The PISA method consistently overestimated MR RV compared with CMR (bias 12±21mL), while no significant bias was found between 3D TTE and CMR (bias 2±14mL). Concordance between echocardiography and CMR was higher using 3D TTE MR grading (intraclass correlation coefficient [ICC]=0.89) than with PISA MR grading (ICC=0.78). Complete agreement with CMR grading was more frequent with 3D TTE than with the PISA method (76% vs 63%).
3D TTE RV assessment using the new generation of automated software correlates well with CMR in patients with isolated degenerative primary MR.
使用三维经胸超声心动图（3D TTE）获得的左心室（LV）容积对原发性二尖瓣反流（MR）进行定量评估，最近取得了令人鼓舞的结果。然而，由于当前的 LV 腔室量化软件产品耗时，3D TTE 并未纳入日常实践中。
研究新的自动化快速 3D TTE 软件（HeartModel；飞利浦医疗保健公司，马萨诸塞州安多弗）在定量评估孤立性退行性原发性 MR 患者的 LV 容积和 MR 严重程度方面的准确性和可重复性；并比较 3D TTE 测量的反流容积（RV）与心脏磁共振（CMR）参考值。
53 例（男 37 例；平均年龄 64±12 岁）至少有轻度原发性孤立性 MR 的患者，在 24 小时内进行了全面的 3D TTE 和 CMR 检查，符合纳入标准。MR RV 使用 CMR 或 3D TTE 的近端等速表面积（PISA）法和容积法（LV 总射血容积减去主动脉射血容积）进行计算。
LV 容积的 3D TTE 观察者内和观察者间的重复性极好（变异性系数≤10%）。使用 CMR 和 3D TTE 测量的 MR RV 相似（57±23mL 与 56±28mL；P=0.22），但使用 PISA 法时明显更高（69±30mL；与 CMR 和 3D TTE 相比，P<0.05）。与 CMR 相比，PISA 法始终高估了 MR RV（偏差 12±21mL），而 3D TTE 与 CMR 之间无显著偏差（偏差 2±14mL）。3D TTE MR 分级的超声心动图与 CMR 的一致性高于 PISA MR 分级（组内相关系数[ICC]=0.89）。与 PISA 法相比，3D TTE 与 CMR 分级完全一致的频率更高（76%比 63%）。
在孤立性退行性原发性 MR 患者中，使用新一代自动化软件进行 3D TTE RV 评估与 CMR 相关性良好。
