Mann H, Denis B, Vanzetto G, Bertrand B, Petit L, Defaye P, Contard M, Machecourt J
Clinique cardiologique et urgences cardiologiques, centre hospitalier universitaire, Grenoble.
Arch Mal Coeur Vaiss. 1994 Mar;87(3):331-7.
Non-invasive quantification of mitral regurgitation remains a clinical problem. The aim of this study was to assess a new methodology of Doppler echocardiographic assessment of the mitral regurgitant fraction. The study included 60 patients (average age 61 years) in sinus rhythm with mitral regurgitation. The cardiac output was measured by Doppler echocardiography at four sites: the aortic, pulmonary and mitral rings and at the tips of the mitral leaflets by a method previously validated and published. Using the average of the aortic and pulmonary cardiac outputs on the hand and the mitral cardiac output on the other, it was possible to calculate the regurgitant fraction: (mean mitral flow-mean aortic/pulmonary flow)/mean mitral flow. This was correlated with the Sellers angiographic grades of regurgitation. The results confirm this validated procedure: the correlation of aortic and pulmonary flows was good: r = 0.94. This also held true for mitral flow at the two sites: r = 0.96. The correlation between the Doppler echocardiographic regurgitant fraction and the angiographic estimation of the severity of mitral regurgitation was good: r = 0.89. There was a statistically significant difference between the Doppler echocardiographic regurgitant fractions corresponding to Sellers Grades I, II and III mitral regurgitation (p = 0.0001). This study shows that Doppler echocardiographic measurements of blood flow at different orifices of the heart applied to the quantification of mitral regurgitation is a reliable method, the use of which, with strict methodological criteria, may be proposed in everyday clinical practice.
二尖瓣反流的无创定量仍是一个临床难题。本研究的目的是评估一种二尖瓣反流分数的多普勒超声心动图评估新方法。该研究纳入了60例窦性心律伴二尖瓣反流的患者（平均年龄61岁）。采用一种先前已验证并发表的方法，通过多普勒超声心动图在四个部位测量心输出量：主动脉环、肺动脉环、二尖瓣环以及二尖瓣叶尖部。用一侧的主动脉和肺动脉心输出量平均值与另一侧的二尖瓣心输出量，可计算反流分数：（二尖瓣平均血流量 - 主动脉/肺动脉平均血流量）/二尖瓣平均血流量。将其与Sellers血管造影反流分级进行相关性分析。结果证实了该验证程序：主动脉和肺动脉血流量的相关性良好：r = 0.94。二尖瓣两个部位血流量的相关性也是如此：r = 0.96。多普勒超声心动图反流分数与二尖瓣反流严重程度的血管造影评估之间的相关性良好：r = 0.89。对应于Sellers I级、II级和III级二尖瓣反流的多普勒超声心动图反流分数之间存在统计学显著差异（p = 0.0001）。本研究表明，应用于二尖瓣反流定量的心脏不同孔口血流的多普勒超声心动图测量是一种可靠的方法，在日常临床实践中，若采用严格的方法学标准，可推荐使用该方法。
