三维超声心动图对二尖瓣狭窄分级及临床事件预测的影响。

Impact of 3D echocardiography on grading of mitral stenosis and prediction of clinical events.

作者信息

Bleakley C, Eskandari M, Aldalati O, Moschonas K, Huang M, Whittaker A, Monaghan M J

机构信息

Cardiology Department, Kings College Hospital, London, UK

出版信息

Echo Res Pract. 2018 Dec 1;5(4):105-111. doi: 10.1530/ERP-18-0031.

DOI:10.1530/ERP-18-0031

PMID:30303687

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6144931/

Abstract

BACKGROUND

The mitral valve orifice area (MVOA) is difficult to assess accurately by 2D echocardiography because of geometric assumptions; therefore, 3D planimetry may offer advantages. We studied the differences in MVOA measurements between the most frequently used methods, to determine if 3D planimetry would result in the re-grading of severity in any cases, and whether it was a more accurate predictor of clinical outcomes.

METHODS

This was a head-to-head comparison of the three most commonly used techniques to grade mitral stenosis (MS) by orifice area and to assess their impact on clinical outcomes. 2D measurements (pressure half-time (PHT), planimetry) and 3D planimetry were performed retrospectively on patients with at least mild MS. The clinical primary endpoint was defined as a composite of MV balloon valvotomy, mitral valve repair or replacement (MVR) and/or acute heart failure (HF) admissions.

RESULTS

Forty-one consecutive patients were included; the majority were female (35; 85.4%), average age 55 (17) years. Mean and peak MV gradients were 9.4 (4) mmHg and 19 (6) mmHg, respectively. 2D and 3D measures of MVOA differed significantly; mean 2D planimetry MVOA was 1.28 (0.40) cm2, mean 3D planimetry MVOA 1.15 (0.29) cm2 (P = 0.003). Mean PHT MVOA was 1.43 (0.44) cm2 (P = 0.046 and P < 0.001 in comparison to 2D and 3D planimetry methods, respectively). 3D planimetry reclassified 7 (17%) patients from mild-to-moderate MS, and 1 (2.4%) from moderate to severe. Overall, differences between the two methods were significant (X2, P < 0.001). Only cases graded as severe by 3D predicted the primary outcome measure compared with mild or moderate cases (odds ratio 5.7).

CONCLUSION

3D planimetry in MS returns significantly smaller measurements, which in some cases results in the reclassification of severity. Routine use of 3D may significantly influence the management of MS, with a degree of prediction of clinical outcomes.

摘要

背景

由于几何假设，二维超声心动图难以准确评估二尖瓣口面积（MVOA）；因此，三维平面测量法可能具有优势。我们研究了最常用方法之间MVOA测量值的差异，以确定三维平面测量法是否会在任何情况下导致严重程度的重新分级，以及它是否是临床结果的更准确预测指标。

方法

这是对三种最常用的二尖瓣狭窄（MS）分级技术按瓣口面积进行的直接比较，并评估它们对临床结果的影响。对至少患有轻度MS的患者进行二维测量（压力减半时间（PHT）、平面测量）和三维平面测量。临床主要终点定义为二尖瓣球囊瓣膜成形术、二尖瓣修复或置换（MVR）和/或急性心力衰竭（HF）入院的综合情况。

结果

纳入了41例连续患者；大多数为女性（35例；85.4%），平均年龄55（17）岁。二尖瓣平均梯度和峰值梯度分别为9.4（4）mmHg和19（6）mmHg。MVOA的二维和三维测量值有显著差异；二维平面测量法的平均MVOA为1.28（0.40）cm²，三维平面测量法的平均MVOA为1.15（0.29）cm²（P = 0.003）。PHT法的平均MVOA为1.43（0.44）cm²（与二维和三维平面测量法相比，P分别为0.046和P < 0.001）。三维平面测量法将7例（17%）患者从轻度MS重新分类为中度MS，1例（2.4%）从中度重新分类为重度。总体而言，两种方法之间的差异具有显著性（X²，P < 0.001）。与轻度或中度病例相比，只有三维测量法分级为重度的病例预测了主要结局指标（比值比5.7）。