Verbeke Jonas, Kamoen Victor, Calle Simon, De Buyzere Marc, Timmermans Frank
Department of Cardiology, University Hospital Ghent, Ghent University, Ghent, Belgium.
Department of Cardiology, University Hospital Ghent, Ghent University, Ghent, Belgium.
J Am Soc Echocardiogr. 2022 Sep;35(9):933-939. doi: 10.1016/j.echo.2022.04.006. Epub 2022 Apr 23.
Recently, an artifactual horizontal extension of the color Doppler signal was described in patients with mitral regurgitation (MR), called color Doppler splay (CDS). This side-lobe artifact was shown to be associated with concealed and significant MR. In the present study, the authors assessed the prognostic significance of CDS and its hemodynamic correlates.
Consecutive patients with primary and secondary MR underwent comprehensive transthoracic echocardiography. Machine settings were fixed for all patients. MR severity was assessed using an integrated approach, as advocated in current international guidelines. The presence of CDS and CDS width and duration were assessed. The outcome measures included the incidence of major adverse cardiac events (a composite of cardiovascular mortality, hospitalization for decompensated heart failure, mitral valve surgery, or percutaneous mitral intervention).
One hundred twenty-seven of 469 patients (27%) with MR demonstrated CDS. The presence of CDS was associated with worse MR, and CDS width correlated with effective regurgitant orifice area, regurgitant volume, and vena contracta width. Mitral annular or leaflet calcification was inversely associated with the presence of CDS. Patients with CDS experienced worse event-free survival. For CDS width, a cutoff of >29 mm was identified as optimal regarding outcome prediction in our cohort and termed "severe CDS." In multivariate Cox regression, the presence of severe CDS was associated with adverse outcome, independent of MR etiology or severity and other clinical and echocardiographic predictors of outcome, and provided incremental prognostic value on top of these parameters.
In patients with MR, the presence of CDS is associated with more severe MR and worse outcomes. Severe CDS provides incremental prognostic value on top of traditional MR metrics and should alert the echocardiographer that MR severity may be underestimated.
最近，在二尖瓣反流（MR）患者中描述了彩色多普勒信号的一种人为水平扩展，称为彩色多普勒散逸（CDS）。这种旁瓣伪像被证明与隐匿性重度MR相关。在本研究中，作者评估了CDS的预后意义及其血流动力学相关性。
连续的原发性和继发性MR患者接受了全面的经胸超声心动图检查。所有患者的机器设置均固定。按照当前国际指南所倡导的，采用综合方法评估MR严重程度。评估CDS的存在情况以及CDS的宽度和持续时间。结局指标包括主要不良心脏事件的发生率（心血管死亡、失代偿性心力衰竭住院、二尖瓣手术或经皮二尖瓣介入治疗的综合指标）。
469例MR患者中有127例（27%）出现CDS。CDS的存在与更严重的MR相关，CDS宽度与有效反流口面积、反流容积和反流束缩流颈宽度相关。二尖瓣环或瓣叶钙化与CDS的存在呈负相关。出现CDS的患者无事件生存期较差。对于CDS宽度，在我们的队列中，>29 mm的截断值被确定为在结局预测方面的最佳值，并称为“重度CDS”。在多变量Cox回归分析中，重度CDS的存在与不良结局相关，独立于MR病因或严重程度以及其他结局的临床和超声心动图预测指标，并且在这些参数之上提供了额外的预后价值。
在MR患者中，CDS的存在与更严重的MR和更差的结局相关。重度CDS在传统MR指标之上提供了额外的预后价值，应提醒超声心动图检查者MR严重程度可能被低估。
