González Vílchez F, Zarauza J, Martín Durán R, Vázquez de Prada J A, Delgado C, Ruano J, Olalla J J, Ares M, Hidalgo M
Sección de Cardiología, Hospital General Yagüe, Burgos.
Rev Esp Cardiol. 1994 Jul;47(7):439-49.
Regurgitant jet area is to date the most widely accepted color Doppler parameter for quantitation of atrium-ventricular regurgitations. In experimental studies, it has been demonstrated that color regurgitant jet area is greatly influenced by technical settings. The present study was aimed to analyze the effect of gain setting, pulse repetition frequency and echocardiographic plane on color jet area in patients with tricuspid regurgitation.
We studied 64 patients with nontrivial (more than 1 cm2), rheumatic tricuspid regurgitation. Examinations were performed in apical four-chamber and right ventricle inflow-tract views, at two gain settings (subsaturation gain and 1/3 reduced gain) and at two pulse repetition frequencies (3.1 and 3.8 kHz). Therefore, every regurgitant jet was study under 8 different technical conditions. The remaining technical settings were held unchanged included throughout the studies. The traced area induced central varianced and aliased signals, as well as the immediately contiguous nonturbulent velocities that were moving in the same direction as the jet. Measurements were taken from 5 and 3 representative cycles in patients with atrial fibrillation and sinus rythm, respectively.
Globally, reduction in gain setting produced a color area decrease by 50%. This reduction was of greater extent for small jets (less than 5 cm2, 45 +/- 17%) with respect to larger jets (more than 5 cm2, 61 +/- 30%, p = 0.0009). Results were similar for both apical four-chamber and right ventricle inflow views and for the two pulse repetition frequencies. At a given color gain level and echocardiographic view, pulse repetition frequency at 3.1 kHz produced greater color areas (by 3-11%) than frequency at 3.8 kHz, but the difference was not significant. Overall, color jet area was significantly greater in right ventricle inflow view than in apical four-chamber view, but substantial individual variability was observed. Difference between both views was greater than 40% in 28% of patients, with the largest color area in right ventricle inflow view in most, especially in those patients with eccentric jets.
Gain setting and echocardiographic view greatly affect regurgitant jet area by color Doppler in patients with tricuspid regurgitation. Therefore, standardization of technical settings is mandatory in order to avoid diagnostic pitfalls.
反流束面积是迄今为止用于定量房室反流最广泛接受的彩色多普勒参数。在实验研究中，已证明彩色反流束面积受技术设置的影响很大。本研究旨在分析增益设置、脉冲重复频率和超声心动图平面对于三尖瓣反流患者彩色反流束面积的影响。
我们研究了64例有显著意义（超过1平方厘米）的风湿性三尖瓣反流患者。检查在心尖四腔心和右心室流入道切面进行，设置两种增益水平（不饱和增益和降低1/3增益）以及两种脉冲重复频率（3.1和3.8千赫兹）。因此，每个反流束在8种不同技术条件下进行研究。在整个研究过程中，其余技术设置保持不变。测量的面积包括中心变异和混叠信号，以及与射流方向相同的紧邻非湍流速度。对于心房颤动和窦性心律患者，分别从5个和3个代表性心动周期进行测量。
总体而言，增益设置降低使彩色反流束面积减少50%。对于小反流束（小于5平方厘米，45±17%），相对于大反流束（大于5平方厘米，61±30%，p = 0.0009），这种减少幅度更大。心尖四腔心切面和右心室流入道切面以及两种脉冲重复频率的结果相似。在给定的彩色增益水平和超声心动图切面上，3.1千赫兹的脉冲重复频率产生的彩色反流束面积比3.8千赫兹时大（3 - 11%），但差异不显著。总体而言，右心室流入道切面的彩色反流束面积显著大于心尖四腔心切面，但观察到个体差异较大。在28%的患者中，两个切面之间的差异大于40%，大多数患者右心室流入道切面的彩色反流束面积最大，尤其是那些反流束偏心的患者。
增益设置和超声心动图切面极大地影响三尖瓣反流患者彩色多普勒测量的反流束面积。因此，为避免诊断陷阱，技术设置标准化是必需的。
