Veyrat C, Ameur A, Bas S, Lessana A, Abitbol G, Kalmanson D
Br Heart J. 1984 Feb;51(2):130-8. doi: 10.1136/hrt.51.2.130.
Pulsed Doppler indices were devised in order to grade the severity of mitral regurgitation on a quantitative basis. Indices were obtained by mapping the regurgitant jet by recording abnormal systolic Doppler signals detected on a "yes/no" basis using a 3 MHz pulsed Doppler velocimeter associated with a cross sectional real time ultrasonic scanner. Combined information from two echographic planes was used to take into account the geometrical three dimensional configuration of the jet. The following dimensions of the jet were measured: (a) the length and the height in the long axis view of the left atrium (long axis regurgitant index (LARI), 0.5 X length X height); (b) the width at the annulus in the short axis view (short axis regurgitant index (SARI); (c) the total regurgitant index (TRI) calculated as the product of LARI multiplied by SARI. Sixteen normal subjects and 94 patients including 46 cases of mitral regurgitation confirmed by angiography (32 of whom proceeded to surgery) were investigated. The diagnostic sensitivity was 91% and the specificity 94%. The jet was detected in 76% of cases. Indices were correlated with independently performed angiographic grading on a three point scale. The best linear correlation was obtained for the TRI; mean values were significantly increased for each grade of severity. Correlations with invasive procedures showed an 87% success rate for the Doppler prediction of the involved regurgitant leaflet(s) and of the anatomical site of the lesion at the annulus. In addition, an abnormal diastolic signal was found in five of the eight patients with ruptured chordae and also a decreased percentage of systolic shortening of the annulus diameter in patients with mitral regurgitation compared with those without.
为了在定量基础上对二尖瓣反流的严重程度进行分级，设计了脉冲多普勒指数。通过使用与实时横截面超声扫描仪相关联的3MHz脉冲多普勒测速仪，以“是/否”的方式记录检测到的异常收缩期多普勒信号，绘制反流束，从而获得指数。来自两个超声平面的综合信息被用于考虑反流束的几何三维结构。测量了反流束的以下尺寸：（a）左心房长轴视图中的长度和高度（长轴反流指数（LARI），0.5×长度×高度）；（b）短轴视图中环周处的宽度（短轴反流指数（SARI））；（c）总反流指数（TRI），计算为LARI乘以SARI的乘积。对16名正常受试者和94名患者进行了研究，其中包括46例经血管造影证实的二尖瓣反流患者（其中32例接受了手术）。诊断敏感性为91%，特异性为94%。在76%的病例中检测到反流束。指数与独立进行的血管造影三点分级相关。TRI获得了最佳线性相关性；每个严重程度等级的平均值均显著增加。与侵入性检查的相关性显示，多普勒预测受累反流瓣叶和瓣环病变解剖部位的成功率为87%。此外，在8例腱索断裂患者中的5例中发现了异常舒张期信号，并且与无二尖瓣反流的患者相比，二尖瓣反流患者的瓣环直径收缩期缩短百分比也降低。
