Enriquez-Sarano M, Tajik A J, Bailey K R, Seward J B
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1993 Apr;21(5):1211-9. doi: 10.1016/0735-1097(93)90248-y.
To determine the influence of jet eccentricity and mechanism of mitral regurgitation, we examined 1) the relation between jet extent and severity of mitral regurgitation, and 2) the use of Doppler color flow imaging for quantitation of mitral regurgitation.
Doppler color flow imaging is widely used to assess mitral regurgitation. However, whether, how and in which subgroups it can quantify regurgitation remain controversial.
In 80 patients with mitral regurgitation, results of color flow Doppler studies obtained in two orthogonal apical views were prospectively compared with quantitative Doppler measurement of the regurgitant volume and the regurgitant fraction. Comparisons were made according to the eccentricity of the jet (group 1 eccentric jets, n = 29; group 2 central jets, n = 51); group 2 was subdivided according to the mechanism of mitral regurgitation (group 2a organic, n = 27; group 2b ischemic or functional, n = 24).
Globally, weak correlations were found between regurgitant volume and jet area (r = 0.57) and regurgitant fraction and jet area/left atrial area ratio (r = 0.65). Groups 1 and 2 showed a correlation between regurgitant volume and jet area (r = 0.68 and r = 0.65, respectively, p < 0.0001), but the slope was steeper in group 2 than in group 1 (0.22 vs. 0.06, p < 0.0001). The same jet area corresponded to more severe regurgitation in group 1 than in group 2 (jet > or = 8 cm2, regurgitant volume 113 +/- 55 vs. 43 +/- 21 ml, p < 0.0001). Similarly, for comparable regurgitant volumes (24 +/- 22 vs. 29 +/- 11 ml, p = NS), group 2a had a smaller jet area than did group 2b (5.3 +/- 6 vs. 9.6 +/- 6 cm2, p < 0.02). Quantitation of regurgitation by Doppler color flow imaging was unreliable in group 1; in group 2b, the regression line between regurgitant fraction and jet area/left atrial area ratio was close to the identity line.
Mitral regurgitant jet eccentricity and mechanism influence jet extent. The same regurgitant volume produces smaller jet areas for eccentric compared with central jets and for central organic compared with ischemic or functional regurgitation. Quantitation of regurgitation using Doppler color flow imaging is possible in ischemic or functional regurgitation but inappropriate in eccentric jets, where quantitative Doppler study should be recommended.
为了确定射流偏心度和二尖瓣反流机制的影响，我们进行了如下研究：1）射流范围与二尖瓣反流严重程度之间的关系；2）利用多普勒彩色血流成像对二尖瓣反流进行定量分析。
多普勒彩色血流成像被广泛用于评估二尖瓣反流。然而，它能否以及如何对反流进行定量分析，以及在哪些亚组中适用，仍存在争议。
对80例二尖瓣反流患者进行前瞻性研究，将在两个相互垂直的心尖视图中获得的彩色多普勒研究结果与反流容积和反流分数的定量多普勒测量结果进行比较。根据射流的偏心度进行分组（第1组为偏心射流，n = 29；第2组为中心射流，n = 51）；第2组再根据二尖瓣反流的机制进行细分（第2a组为器质性，n = 27；第2b组为缺血性或功能性，n = 24）。
总体而言，反流容积与射流面积之间的相关性较弱（r = 0.57），反流分数与射流面积/左心房面积比值之间的相关性也较弱（r = 0.65）。第1组和第2组中，反流容积与射流面积之间均存在相关性（分别为r = 0.68和r = 0.65，p < 0.0001），但第2组的斜率比第1组更陡（0.22对0.06，p < 0.0001）。相同的射流面积在第1组中对应的反流比第2组更严重（射流≥8 cm²时，反流容积为113±55 vs. 43±21 ml, p < 0.0001）。同样，对于可比的反流容积（24±22 vs. 29±11 ml, p = 无显著性差异），第2a组的射流面积比第2b组小（5.3±6 vs. 9.6±6 cm², p < 0.02）。在第1组中，利用多普勒彩色血流成像对反流进行定量分析不可靠；在第2b组中，反流分数与射流面积/左心房面积比值之间的回归线接近恒等线。
二尖瓣反流射流的偏心度和机制影响射流范围。与中心射流相比，相同的反流容积产生的偏心射流面积更小；与缺血性或功能性反流相比，中心器质性反流产生的射流面积更小。利用多普勒彩色血流成像对缺血性或功能性反流进行反流定量分析是可行的，但在偏心射流中不适用，对于偏心射流，建议采用定量多普勒研究。
