Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, NJ (S.U., L.A., L.M., K.K., L.G.).
Department of Medicine, Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai School of Medicine, New York, NY (E.A., G.L.).
Circ Cardiovasc Imaging. 2020 May;13(5):e010278. doi: 10.1161/CIRCIMAGING.119.010278. Epub 2020 May 15.
The American College of Cardiology/American Heart Association and American Society of Echocardiography guidelines recommend assessing several echocardiographic parameters when evaluating mitral regurgitation (MR) severity. These parameters can be discordant, making the assessment of MR challenging. The degree to which echocardiographic parameters of MR severity are concordant is not well studied.
We enrolled 159 patients in a prospective multicenter study. Eight parameters were included in this analysis: proximal isovelocity surface area (PISA)-derived regurgitant volume, PISA-derived effective regurgitant orifice area, vena contracta, color Doppler jet/left atrial area, left atrial volume index, left ventricular end-diastolic volume index, peak E wave, and the presence of pulmonary vein systolic reversal. Each echocardiographic parameter was determined to represent severe or nonsevere MR according to the American Society of Echocardiography guidelines. A concordance score was calculated as [Formula: see text] so that a higher score reflects greater concordance. There was no discordance when all the echocardiographic parameters agreed and high discordance when 3 or 4 parameters were discordant.
The mean concordance score was 75±14% for the entire cohort. There were 9 (6%) patients with complete agreement of all parameters and 61 (38%) with high discordance. There was greater discordance in patients with severe MR but no difference between primary versus secondary or central versus eccentric jets. There was an improvement in concordance when only considering PISA-based regurgitant volume, PISA-based effective regurgitant orifice area, and vena contracta with agreement in 68% of patients.
There was limited concordance between the echocardiographic parameters of MR severity, and the discordance was worse with more severe MR. Concordance improved when considering only 3 quantitative measures of vena contracta and PISA-based effective regurgitant orifice area and regurgitant volume. These findings highlight the challenges facing echocardiographers when assessing the severity of MR and emphasize the difficulty of using an integrated approach that incorporates multiple components. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04038879.
美国心脏病学会/美国心脏协会和美国超声心动图学会指南建议在评估二尖瓣反流 (MR) 严重程度时评估几个超声心动图参数。这些参数可能不一致，使得 MR 的评估具有挑战性。MR 严重程度的超声心动图参数的一致性程度尚未得到很好的研究。
我们在一项前瞻性多中心研究中纳入了 159 名患者。本分析包括 8 个参数：基于近端等速表面积 (PISA) 的反流容积、PISA 衍生的有效反流口面积、收缩期瓣口、彩色多普勒射流/左心房面积、左心房容积指数、左心室舒张末期容积指数、峰值 E 波和肺静脉收缩期反转。根据美国超声心动图学会指南，每个超声心动图参数均被确定为代表严重或非严重的 MR。一致性评分计算为 [公式：见文本]，因此评分越高反映一致性越高。当所有超声心动图参数一致时没有不一致，当 3 或 4 个参数不一致时存在高度不一致。
整个队列的平均一致性评分为 75±14%。有 9 名（6%）患者的所有参数完全一致，61 名（38%）患者的参数高度不一致。严重 MR 的患者之间存在更大的不一致，但原发性与继发性或中央与偏心射流之间没有差异。当仅考虑基于 PISA 的反流容积、基于 PISA 的有效反流口面积和收缩期瓣口时，一致性有所提高，68%的患者一致。
MR 严重程度的超声心动图参数之间的一致性有限，且随着 MR 更加严重，不一致性更大。当仅考虑 3 个定量的收缩期瓣口和基于 PISA 的有效反流口面积和反流容积的测量值时，一致性得到改善。这些发现突出了超声心动图医师在评估 MR 严重程度时面临的挑战，并强调了使用整合多个组件的综合方法的困难。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT04038879。
