Enriquez-Sarano M, Bailey K R, Seward J B, Tajik A J, Krohn M J, Mays J M
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Circulation. 1993 Mar;87(3):841-8. doi: 10.1161/01.cir.87.3.841.
Quantitation of valvular regurgitation remains a challenge. The accuracy of quantitative Doppler is controversial, and its ability to measure regurgitant volume is unknown; therefore, it is not widely used.
In 120 patients (20 without regurgitation, 19 with aortic regurgitation, and 81 with mitral regurgitation), the stroke volume through the mitral annulus and left ventricular outflow tract were measured using pulsed-wave Doppler concurrently with left ventricular stroke volume calculated using left ventricular volumes measured by two-dimensional echocardiography Simpson's biapical method. Regurgitant volume and fraction were thus computed using Doppler or ventricular methods. In normal patients there were good correlations between Doppler and left ventricular measurements of stroke volume. Doppler regurgitant volume and fraction were 4.4 +/- 4.4 mL and 5.3 +/- 4.5%, respectively. In patients with aortic regurgitation, there were good correlations between Doppler and left ventricular measurements of stroke volume, regurgitant volume, and regurgitant fraction (r = 0.97, r = 0.95, and r = 0.93, respectively; p < 0.0001). In patients with mitral regurgitation, despite good correlations between Doppler and ventricular methods for stroke volume, regurgitant volume, and regurgitant fraction (r = 0.94, r = 0.93, and r = 0.94, respectively; p < 0.001), these variables were overestimated by Doppler. However, in the last 54 patients compared with the first 27, overestimation decreased significantly for regurgitant volume (5 +/- 10 mL versus 18 +/- 27 mL, p < 0.05) and regurgitant fraction (3.3 +/- 6.7% versus 6.2 +/- 6.8%, p = 0.05).
Quantitative Doppler can be performed in large numbers of patients in a clinical laboratory. Its potential limitation was identified as overestimation of mitral regurgitation, which is overcome with increased experience. Its achieved accuracy in mitral and aortic regurgitation allows measurement not only of regurgitant fraction but most importantly of regurgitant volume.
瓣膜反流的定量分析仍然是一项挑战。定量多普勒的准确性存在争议，其测量反流容积的能力尚不清楚；因此，它未被广泛应用。
在120例患者中（20例无反流，19例有主动脉反流，81例有二尖瓣反流），使用脉冲波多普勒测量通过二尖瓣环和左心室流出道的每搏输出量，同时使用二维超声心动图辛普森双平面法测量左心室容积计算左心室每搏输出量。由此使用多普勒或心室方法计算反流容积和反流分数。在正常患者中，多普勒测量的每搏输出量与左心室测量值之间存在良好的相关性。多普勒反流容积和反流分数分别为4.4±4.4 mL和5.3±4.5%。在主动脉反流患者中，多普勒测量的每搏输出量、反流容积和反流分数与左心室测量值之间存在良好的相关性（分别为r = 0.97、r = 0.95和r = 0.93；p < 0.0001）。在二尖瓣反流患者中，尽管多普勒方法与心室方法在每搏输出量、反流容积和反流分数方面存在良好的相关性（分别为r = 0.94、r = 0.93和r = 0.94；p < 0.001），但这些变量被多普勒高估。然而，与前27例患者相比，在最后54例患者中，反流容积（5±10 mL对18±27 mL，p < 0.05）和反流分数（3.3±6.7%对6.2±6.8%，p = 0.05）的高估显著降低。
定量多普勒可在临床实验室对大量患者进行检测。其潜在局限性被确定为对二尖瓣反流的高估，随着经验增加可克服这一问题。其在二尖瓣和主动脉反流中所达到的准确性不仅允许测量反流分数，最重要的是允许测量反流容积。
