Department of Emergency Medicine, Bozyaka Training and Research Hospital, Izmir, Turkey.
Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
J Ultrasound Med. 2019 Apr;38(4):1027-1038. doi: 10.1002/jum.14791. Epub 2018 Sep 28.
The purpose of this study was to determine the success of mitral valve movements in the estimation of left ventricular ejection fraction (LVEF).
Adult patients whose principal symptom was dyspnea were included in this prospective observational study. The distance from the anterior mitral valve (AMV) to the interventricular septum (IVS) during early diastole was measured first in B-mode in the parasternal long axis (PLAX) named parasternal long axis-anterior leaflet septal separation. Second, the AMV-IVS distance was measured in M-mode in the PLAX named E-point septal separation. Third, AMV-IVS distance was measured in B-mode in the apical 4-chamber view named apical 4-chamber view-anterior leaflet septal separation. Finally, maximum distance between the 2 mitral leaflets in the apical 4-chamber view was measured and named mitral valve leaflet separation. Comprehensive echocardiography was performed by an experienced cardiologist. Correlation was calculated between mitral valve measurements and LVEF. Cutoff values were determined using receiver operating characteristic curves and the chi-square test.
A total of 118 patients were included in the study. Parasternal long axis-anterior leaflet septal separation, E-point septal separation, and apical 4-chamber view-anterior leaflet septal separation were highly correlated with LVEF (correlation coefficient, -0.848, -0.833, and-0.822 [P < .001]). Parasternal long axis-anterior leaflet septal separation values less than 2.30 mm, E-point septal separation values less than 2 mm, and mitral valve leaflet separation values greater than 25.15 mm exhibited a 100% negative predictive value in excluding reduced LVEF. Parasternal long axis-anterior leaflet septal separation values less than 4.95 mm, EPSS values less than 5.85 mm, apical 4-chamber view-anterior leaflet septal separation values less than 6.95 mm, and mitral valve leaflet separation values greater than 24.05 mm exhibited a 100% negative predictive value in excluding severe reduced LVEF.
Mitral valve measurement methods may be useful in predicting LVEF or values thereof as a complementary method of diagnosing challenging patients on echocardiographic images.
本研究旨在确定二尖瓣运动在左心室射血分数（LVEF）估计中的成功率。
本前瞻性观察研究纳入了以呼吸困难为主诉的成年患者。首先在胸骨旁长轴（PLAX）的 B 模式下测量二尖瓣前叶（AMV）至室间隔（IVS）在舒张早期的距离，命名为胸骨旁长轴-前叶间隔分离（parasternal long axis-anterior leaflet septal separation）。其次，在 PLAX 的 M 模式下测量 AMV-IVS 距离，命名为 E 点室间隔分离（E-point septal separation）。再次，在心尖 4 腔视图的 B 模式下测量 AMV-IVS 距离，命名为心尖 4 腔视图-前叶间隔分离（apical 4-chamber view-anterior leaflet septal separation）。最后，测量心尖 4 腔视图中 2 个二尖瓣叶之间的最大距离，并命名为二尖瓣叶分离（mitral valve leaflet separation）。由经验丰富的心脏病专家进行全面超声心动图检查。计算二尖瓣测量值与 LVEF 之间的相关性。使用受试者工作特征曲线和卡方检验确定截断值。
共纳入 118 例患者。胸骨旁长轴-前叶间隔分离、E 点室间隔分离和心尖 4 腔视图-前叶间隔分离与 LVEF 高度相关（相关系数分别为-0.848、-0.833 和-0.822 [P < 0.001]）。胸骨旁长轴-前叶间隔分离值小于 2.30 mm、E 点室间隔分离值小于 2 mm 和二尖瓣叶分离值大于 25.15 mm 在排除降低的 LVEF 方面具有 100%的阴性预测值。胸骨旁长轴-前叶间隔分离值小于 4.95 mm、EPSS 值小于 5.85 mm、心尖 4 腔视图-前叶间隔分离值小于 6.95 mm 和二尖瓣叶分离值大于 24.05 mm 在排除严重降低的 LVEF 方面具有 100%的阴性预测值。
二尖瓣测量方法可用于预测 LVEF 或其值，作为超声心动图图像上诊断有挑战性患者的补充方法。
