经食管超声心动图房室平面双切面技术对二尖瓣解剖结构的诊断准确性。
Diagnostic Accuracy of Transesophageal Echocardiographic Commissural-Biplane Approach in Identifying Mitral Valve Anatomy.
机构信息
Division of Cardiology, Department of Medicine, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
Division of Cardiothoracic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
出版信息
J Am Soc Echocardiogr. 2023 Sep;36(9):956-962. doi: 10.1016/j.echo.2023.04.008. Epub 2023 Apr 15.
BACKGROUND
Transesophageal echocardiography (TEE) conventional multiplane approach (MPA) and the newly proposed commissural-biplane approach (CBA) are the recommended algorithms for identifying the affected mitral valve (MV) segments in the setting of mitral regurgitation. To date, there are no reports to address the diagnostic performance of CBA. In this study we aim to analyze the diagnostic accuracy of CBA and MPA in comparison with three-dimensional echocardiographic findings in patients with severe mitral regurgitation.
METHODS
We prospectively enrolled 102 patients with severe mitral regurgitation. All patients underwent systematic TEE assessment of MV before surgical intervention to define the affected MV segments/scallops. The standard MPA includes 4-chamber, 2-chamber, long-axis, and commissural views; CBA was performed by obtaining the bicommissural view and simultaneous biplane imaging of the medial, middle, and lateral MV aspects. The findings of both TEE approaches were compared with three-dimensional TEE data to assess the diagnostic accuracy of MPA and CBA.
RESULTS
The mean patient age was (65 ± 11) years, and 37 (36.3%) were female. We found that CBA had an overall diagnostic accuracy between 88% and 97% in identifying the abnormal MV scallops; in contrast, MPA accuracy ranged between 82% and 95%. The CBA and MPA were the least accurate in identifying the P3 scallop-88% and 82% respectively; however, both were the most accurate in assessing the A2 segment-95% and 97%, respectively. The sensitivity of identifying commissural abnormalities was 80% with CBA and 30% with MPA. Three-dimensional TEE was found to have a strong agreement with CBA (averaged kappa of 0.81, P < .0001) and a modest agreement with MPA (averaged kappa of 0.61, P < .0001) in identifying abnormal anterior or posterior segments. On the other hand, three-dimensional TEE had a weak agreement with CBA (kappa of 0.43, P < .0001) and no agreement with MPA (kappa of 0.14, P = .153) in the assessment of commissural involvements.
CONCLUSION
The CBA is more accurate than the MPA in the assessment of MV commissural involvement. Given the accuracy differences of the 2 approaches for specific leaflet/scallops, a comprehensive evaluation using both approaches is recommended for all MV scallop assessments.
背景
经食管超声心动图（TEE）传统的多平面法（MPA）和新提出的二尖瓣连合双平面法（CBA）是识别二尖瓣反流患者受累二尖瓣（MV）节段的推荐算法。迄今为止，尚无关于 CBA 诊断性能的报告。在本研究中，我们旨在分析 CBA 和 MPA 与三维超声心动图在重度二尖瓣反流患者中的诊断准确性。
方法
我们前瞻性纳入 102 例重度二尖瓣反流患者。所有患者均在外科干预前接受系统 TEE 评估 MV，以确定受累 MV 节段/瓣叶。标准 MPA 包括四腔心、两腔心、长轴和连合视图；CBA 通过获取双连合视图和内侧、中间和外侧 MV 平面的同时双平面成像来进行。将两种 TEE 方法的结果与三维 TEE 数据进行比较，以评估 MPA 和 CBA 的诊断准确性。
结果
患者平均年龄（65±11）岁，其中 37 例（36.3%）为女性。我们发现，CBA 在识别异常 MV 瓣叶方面的总体诊断准确性在 88%至 97%之间；相比之下，MPA 的准确性范围在 82%至 95%之间。CBA 和 MPA 识别 P3 瓣叶最不准确，分别为 88%和 82%；然而，两者在评估 A2 节段方面最准确，分别为 95%和 97%。CBA 识别连合异常的敏感性为 80%，而 MPA 为 30%。三维 TEE 在识别异常前或后节段方面与 CBA 具有很强的一致性（平均kappa 值为 0.81，P<.0001），与 MPA 具有中等一致性（平均 kappa 值为 0.61，P<.0001）。另一方面，三维 TEE 在评估连合受累方面与 CBA 一致性较弱（kappa 值为 0.43，P<.0001），与 MPA 无一致性（kappa 值为 0.14，P=.153）。
结论
CBA 在评估 MV 连合受累方面比 MPA 更准确。鉴于两种方法在特定瓣叶/瓣叶的准确性差异，建议对所有 MV 瓣叶进行评估时同时使用两种方法进行全面评估。
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