在功能性二尖瓣反流定量分析中，三维缩流颈面积相较于基于二维的超声心动图方法的优势。
Benefit of 3D Vena Contracta Area over 2D-Based Echocardiographic Methods in Quantification of Functional Mitral Valve Regurgitation.
作者信息
Jungels Vinzenz M, Heidrich Felix M, Pfluecke Christian, Linke Axel, Sveric Krunoslav M
机构信息
Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307 Dresden, Germany.
Department of Internal Medicine I, Städtisches Klinikum Görlitz, Girbigsdorfer Straße 1-3, 02828 Görlitz, Germany.
出版信息
Diagnostics (Basel). 2023 Mar 19;13(6):1176. doi: 10.3390/diagnostics13061176.
BACKGROUND
The two-dimensional proximal isovelocity surface area (2D PISA) method in the quantification of an effective regurgitation orifice area (EROA) has limitations in functional mitral valve regurgitation (FMR), particularly in non-circular coaptation defects.
OBJECTIVE
We aimed to validate a three-dimensional vena contracta area (3D VCA) against a conventional EROA using a 2D PISA method and anatomic regurgitation orifice area (AROA) in patients with FMR.
METHODS
Both 2D and 3D full-volume color Doppler data were acquired during consecutive transoesophageal echocardiography (TEE) examinations. The EROA 2D PISA was calculated as recommended by current guidelines. Multiplanar reconstruction was used for offline analysis of the 3D VCA (with a color Doppler) and AROA (without a color Doppler). Receiver operating characteristic (ROC) analysis was used to calculate a cut-off value for the 3D VCA to discriminate between moderate and severe FMR as classified by the EROA 2D PISA.
RESULTS
From 2015 to 2018, 105 consecutive patients with complete and adequate imaging data were included. The 3D VCA correlated strongly with the 2D PISA EROA and AROA (r = 0.93 and 0.94). In the presence of eccentric or multiple regurgitant jets, there was no significant difference in correlations with the 3D VCA. We found a 3D VCA cut-off of 0.43 cm to discriminate between moderate and severe FMR (area under curve = 0.98). The 3D VCA showed a higher interobserver agreement than the EROA 2D PISA (interclass correlation coefficient: 0.94 vs. 0.81).
CONCLUSIONS
The 3D VCA has excellent validity and lower variability than the conventional 2D PISA in FMR. Compared to the 2D PISA, the 3D VCA was not affected by the presence of eccentric or multiple regurgitation jets or non-circular regurgitation orifices. With a threshold of 0.43 cm for the 3D VCA, we demonstrated reliable discrimination between moderate and severe FMR.
背景
二维近端等速表面积（2D PISA）法在定量有效反流口面积（EROA）方面，对于功能性二尖瓣反流（FMR）存在局限性，尤其是在非圆形瓣叶对合缺损的情况下。
目的
我们旨在通过二维PISA法及解剖反流口面积（AROA），在FMR患者中验证三维缩流颈面积（3D VCA）与传统EROA的相关性。
方法
在连续的经食管超声心动图（TEE）检查期间，采集二维和三维全容积彩色多普勒数据。按照当前指南推荐计算2D PISA法的EROA。采用多平面重建对3D VCA（使用彩色多普勒）和AROA（不使用彩色多普勒）进行离线分析。采用受试者工作特征（ROC）分析计算3D VCA区分中度和重度FMR的临界值，FMR程度由2D PISA法的EROA分类。
结果
2015年至2018年，纳入了105例具有完整且充分影像数据的连续患者。3D VCA与2D PISA法的EROA及AROA显著相关（r = 0.93和0.94）。在存在偏心或多个反流束的情况下，与3D VCA的相关性无显著差异。我们发现3D VCA的临界值为0.43 cm，可区分中度和重度FMR（曲线下面积 = 0.98）。3D VCA的观察者间一致性高于2D PISA法的EROA（组内相关系数：0.94对0.81）。
结论
在FMR中，3D VCA具有比传统2D PISA更好的有效性和更低的变异性。与2D PISA相比，3D VCA不受偏心或多个反流束或非圆形反流口的影响。3D VCA阈值为0.43 cm时，我们证明了在中度和重度FMR之间具有可靠的区分能力。
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