Pieper E P, Hellemans I M, Hamer H P, Ravelli A C, Cheriex E C, Tijssen J G, Lie K I, Visser C A
University Hospital Groningen, Department of Cardiology, The Netherlands.
Am J Cardiol. 1996 Aug 15;78(4):444-50. doi: 10.1016/s0002-9149(96)00335-9.
We evaluated the value of color and pulsed Doppler transesophageal echocardiographic parameters and of V waves in estimating the severity of mitral regurgitation (MR) in 62 consecutive patients (38 men and 24 women, aged 39 to 80 years) with angiographically proven chronic pure MR (15 grade I/II, 47 grade III/IV). Twenty patients were examined before cardiac surgery under general anesthesia. Sensitivity, specificity, and positive and negative predictive values of systolic pulmonary venous flow reversal for the presence of grade III/IV MR were 87%, 93%, 98%, and 64%, respectively, these were for jet areas > or = 8.0 cm2--66%, 100%, 100%, and 48%, for jet lengths > or = 50 mm--70%, 87%, 94%, and 48%, for enlarged V waves--86%, 38%, 83%, and 43%, and for either flow reversal or a jet area > or = 8.0 cm2--96%, 93%, 98%, and 88%. We conclude that a combination of measurements improved the negative predictive value considerably, which is of importance in a population with a high pretest probability of severe MR. Enlarged V waves are not reliable in predicting severe MR. The optimal cutoff value for jet area and jet length was lower in anesthesized patients than in conscious patients; in anesthesized patients, sensitivity, specificity, and positive and negative predictive values of jet area > or = 5.0 CM2 for grade III/IV MR were 67%, 100%, 100%, and 50%, respectively; these were 87%, 100%, 100%, and 71% for flow reversal. Because the results of mitral repair are often evaluated with transesophageal echocardiography during surgery, our findings have clinical implications for evaluation of severe MR in anesthesized patients: pulmonary venous flow direction is the first-choice measure; jet area can be used when a low cutoff point is chosen.
我们评估了彩色及脉冲多普勒经食管超声心动图参数以及V波在评估62例经血管造影证实为慢性单纯二尖瓣反流（MR）患者（38例男性和24例女性，年龄39至80岁）二尖瓣反流严重程度中的价值，其中15例为I/II级，47例为III/IV级。20例患者在全身麻醉下心脏手术前接受检查。收缩期肺静脉血流逆转对于存在III/IV级MR的敏感性、特异性、阳性预测值和阴性预测值分别为87%、93%、98%和64%；对于射流面积≥8.0 cm²分别为66%、100%、100%和48%；对于射流长度≥50 mm分别为70%、87%、94%和48%；对于增大的V波分别为86%、38%、83%和43%；对于血流逆转或射流面积≥8.0 cm²分别为96%、93%、98%和88%。我们得出结论，多种测量方法的组合可显著提高阴性预测值，这在重度MR预测试概率较高的人群中很重要。增大的V波在预测重度MR方面不可靠。麻醉患者中射流面积和射流长度的最佳截断值低于清醒患者；在麻醉患者中，射流面积≥5.0 cm²对于III/IV级MR的敏感性、特异性、阳性预测值和阴性预测值分别为67%、100%、100%和50%；对于血流逆转分别为87%、100%、100%和71%。由于手术期间经常通过经食管超声心动图评估二尖瓣修复结果，我们的研究结果对麻醉患者重度MR的评估具有临床意义：肺静脉血流方向是首选测量方法；当选择较低截断点时可使用射流面积。
