Houda N, Takeuchi M, Morita N, Nakano T, Takezawa H
J Cardiogr. 1985 Jun;15(2):449-67.
The sensitivity and specificity of detecting and estimating mitral regurgitation were assessed by two-dimensional pulsed Doppler echocardiography (PDE) for 85 patients, aged 17 to 79 years. Mitral regurgitation was clinically diagnosed in 10 patients, and confirmed by angiography in 60 patients. Using real time two-dimensional images and M-mode displays, the sample volumes were taken at 36 sites, including the mitral ostium, the left atrium, and the left ventricular inflow tract. Doppler signals were analyzed by the FFT method and the diagnosis of mitral regurgitation was based on the systolic turbulence with a wide range of velocities greater than +/- 1 KHz. The results obtained were as follows: In 61 of 70 cases with mitral regurgitation, distinctly abnormal systolic Doppler signals were detected at the mitral ostium or within the left atrium, which were not recorded in the other 15 cases without angiocardiographically documented mitral regurgitation. The signals had either unidirectional or bidirectional wide frequency-band patterns, which were thought to indicate the systolic turbulence caused by mitral regurgitation, because these were occasionally recorded beyond the second heart sound, and increased with the administration of methoxamine and diminished after the inhalation of amyl nitrite. When mitral regurgitation was graded I degree, II degree, III degree and IV degree based on Sellers' classification, a PDE sensitivity for detecting mitral regurgitation was 78.1, 89.5, 100 and 100%, respectively. When approaches were divided by the parasternal long-axis, parasternal short-axis and apical long-axis, a PDE sensitivity was 80.0, 74.2, and 70.0%, respectively. The PDE was highly sensitive in diagnosing mitral regurgitation due to rheumatic valvular disease, mitral valve prolapse or ruptured chordae tendineae (sensitivity 100%), but it was less sensitive in ischemic heart disease, dilated cardiomyopathy or hypertrophic cardiomyopathy. Nine cases in which mitral regurgitation was missed by PDE, mitral regurgitation was mild (seven cases: Sellers I degree, two cases: Sellers II degree). No false positives were found. The overall sensitivity of the PDE was 87.1%, with a specificity of 100%, a diagnostic accuracy of 89.4%, and a predictive value of 100%. By displaying the distribution of systolic turbulence on parasternal or apical long-axis image (flow mapping), the direction and the extent of the regurgitant flow in the left atrium were clearly visualized. The localization of the regurgitant flow at the mitral ostium was visualized in parasternal short-axis images by the flow mapping method.(ABSTRACT TRUNCATED AT 400 WORDS)
采用二维脉冲多普勒超声心动图（PDE）对85例年龄在17至79岁之间的患者检测和评估二尖瓣反流的敏感性和特异性。临床上诊断出10例二尖瓣反流，60例经血管造影证实。利用实时二维图像和M型显示，在36个部位采集样本容积，包括二尖瓣口、左心房和左心室流入道。采用快速傅里叶变换（FFT）方法分析多普勒信号，二尖瓣反流的诊断基于收缩期湍流，其速度范围广泛，大于+/-1千赫兹。结果如下：在70例二尖瓣反流病例中的61例，在二尖瓣口或左心房内检测到明显异常的收缩期多普勒信号，而在其他15例无心血管造影记录的二尖瓣反流病例中未记录到。这些信号具有单向或双向宽频带模式，被认为表明二尖瓣反流引起的收缩期湍流，因为这些信号偶尔会在第二心音之后记录到，并随着甲氧明的给药而增加，吸入亚硝酸异戊酯后减弱。根据塞勒斯分类法将二尖瓣反流分为I度、II度、III度和IV度时，PDE检测二尖瓣反流的敏感性分别为78.1%、89.5%、100%和100%。当按胸骨旁长轴、胸骨旁短轴和心尖长轴划分检测方法时，PDE的敏感性分别为80.0%、74.2%和70.0%。PDE对风湿性瓣膜病、二尖瓣脱垂或腱索断裂引起的二尖瓣反流诊断高度敏感（敏感性100%），但对缺血性心脏病、扩张型心肌病或肥厚型心肌病的敏感性较低。PDE漏诊的9例二尖瓣反流病例中，二尖瓣反流程度较轻（7例：塞勒斯I度，2例：塞勒斯II度）。未发现假阳性。PDE的总体敏感性为87.1%，特异性为100%，诊断准确性为89.4%，预测值为100%。通过在胸骨旁或心尖长轴图像上显示收缩期湍流的分布（血流图），可清晰显示左心房反流血流的方向和范围。通过血流图方法在胸骨旁短轴图像上可显示二尖瓣口反流血流的定位。（摘要截短至400字）
