Peng Lingli, Zhang Xin, Zhang Li, Wang Jing, Fang Lingyun, Xie Mingxing, Wu Wenqian
Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5023-5037. doi: 10.21037/qims-2024-2552. Epub 2025 May 28.
The diagnostic utility of transthoracic echocardiographic Doppler parameters in differentiating between normal and abnormal function of the mechanical prosthetic tricuspid valve (MPTV) has not been thoroughly investigated. This study aimed to evaluate the diagnostic accuracy and determine the optimal cutoff values of Doppler parameters in the detection of MPTV dysfunction.
We retrospectively analyzed 91 patients who underwent MPTV replacement over the past 12 years. The study cohort was divided into two groups: an experimental group consisting of 15 patients with 16 separate episodes of MPTV dysfunction, and a control group comprising 76 patients with normal leaflet function. Doppler parameters were measured at the tricuspid valve (TV) position included pressure half-time (PHT), peak early tricuspid diastolic velocity (E velocity), mean gradient (MG), velocity-time integral (VTI), effective orifice area (EOA), and the ratio of VTI to velocity-time integral of the left ventricular outflow tract (VTI ratio). Logistic regression analysis was performed to identify predictors for MPTV dysfunction, and the predictive ability of Doppler parameters was assessed using receiver operating characteristic (ROC) curve.
Compared to the control group, patients with MPTV dysfunction exhibited significantly higher values for PHT (298.6±95.3 111.3±27.4 ms), E velocity (2.4±0.5 1.4±0.3 m/s), MG (14.5±6.0 3.2±1.5 mmHg), VTI (112.4±43.7 37.7±9.7 cm), and VTI ratio (6.2±2.8 1.9±0.6), along with a smaller EOA (0.6±0.3 1.8±0.6 cm). All of these above parameters showed significant differences (P<0.001). Logistic regression and ROC curve analyses identified predictors for MPTV dysfunction: PHT >179 ms, E velocity >2.0 m/s, MG >6.9 mmHg, VTI >60 cm, VTI ratio >3.4, and EOA <1.0 cm. The area under the curve (AUC) for these parameters exceeded 0.95, indicating excellent diagnostic accuracy.
The study highlights the significant diagnostic utility of transthoracic echocardiographic Doppler parameters in identifying MPTV dysfunction. A multiparameter algorithm integrating PHT, E velocity, MG, VTI ratio, and EOA was created to effectively distinguish between dysfunctional and normally functioning MPTVs. This algorithm provides a valuable tool for enhancing clinical decision-making and optimizing patient management. Further prospective studies are warranted to validate these findings and refine the diagnostic criteria.
经胸超声心动图多普勒参数在鉴别机械性人工三尖瓣（MPTV）功能正常与异常方面的诊断效用尚未得到充分研究。本研究旨在评估诊断准确性，并确定多普勒参数在检测MPTV功能障碍时的最佳截断值。
我们回顾性分析了过去12年中接受MPTV置换术的91例患者。研究队列分为两组：实验组由15例发生16次MPTV功能障碍的患者组成，对照组由76例瓣叶功能正常的患者组成。在三尖瓣（TV）位置测量多普勒参数，包括压力减半时间（PHT）、舒张早期三尖瓣峰值速度（E速度）、平均压差（MG）、速度时间积分（VTI）、有效瓣口面积（EOA）以及VTI与左心室流出道速度时间积分的比值（VTI比值）。进行逻辑回归分析以确定MPTV功能障碍的预测因素，并使用受试者工作特征（ROC）曲线评估多普勒参数的预测能力。
与对照组相比，MPTV功能障碍患者的PHT（298.6±95.3对111.3±27.4毫秒）、E速度（2.4±0.5对1.4±0.3米/秒）、MG（14.5±6.0对3.2±1.5毫米汞柱）、VTI（112.4±43.7对37.7±9.7厘米）和VTI比值（6.2±2.8对1.9±0.6）显著更高，而EOA更小（0.6±0.3对1.8±0.6平方厘米）。所有上述参数均显示出显著差异（P<0.001）。逻辑回归和ROC曲线分析确定了MPTV功能障碍的预测因素：PHT>179毫秒、E速度>2.0米/秒、MG>6.9毫米汞柱、VTI>60厘米、VTI比值>3.4以及EOA<1.0平方厘米。这些参数的曲线下面积（AUC）超过0.95，表明诊断准确性极佳。
本研究强调了经胸超声心动图多普勒参数在识别MPTV功能障碍方面的重要诊断效用。创建了一种整合PHT、E速度、MG、VTI比值和EOA的多参数算法，以有效区分功能障碍和功能正常的MPTV。该算法为加强临床决策和优化患者管理提供了有价值的工具。有必要进行进一步的前瞻性研究以验证这些发现并完善诊断标准。
