Klarich K W, Rihal C S, Nishimura R A
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
J Am Soc Echocardiogr. 1996 Sep-Oct;9(5):684-90. doi: 10.1016/s0894-7317(96)90065-6.
The purpose of this study was to assess the variability of measuring the mitral valve area (MVA) by the cardiac catheterization (Gorlin) method and two Doppler echocardiographic methods, the pressure half-time and continuity equation methods. The determinants of MVA were measured simultaneously before and after percutaneous mitral balloon valvuloplasty (PBMV). Thirty-three patients with severe mitral stenosis underwent simultaneous measurements of MVA by the three methods immediately before and within 15 minutes after PBMV. After combining all data, the correlation between the catheterization and pressure half-time methods was significant (r = 0.65; p < 0.001), as was that between the catheterization and continuity equation methods (r = 0.64; p < 0.001). However, there was a large degree of variability among the measurements with the three techniques. The mean difference between the catheterization and pressure half-time methods of measuring MVA before PBMV was -0.2 +/- 0.4 cm2 and 0.1 +/- 0.3 cm2 between the catheterization and continuity equation methods. This variability was even more marked after PBMV: -0.5 +/- 0.9 cm2 between the catheterization and pressure half-time methods and 0.4 +/- 0.6 cm2 between the catheterization and continuity equation methods. Although previous studies have shown a good correlation between MVA as measured with the catheterization and two Doppler echocardiographic methods, they included a wide range of MVAs. In our study of patients with hemodynamically significant mitral stenosis, there was a large degree of variability between the catheterization and simultaneously performed Doppler echocardiographic methods. The calculated MVA by any method should not be used as the single measure of severity of stenosis.
本研究的目的是评估通过心导管检查（戈林）法以及两种多普勒超声心动图方法（压力减半时间法和连续方程法）测量二尖瓣面积（MVA）的变异性。在经皮二尖瓣球囊成形术（PBMV）前后同时测量MVA的决定因素。33例重度二尖瓣狭窄患者在PBMV前即刻和术后15分钟内通过三种方法同时测量MVA。综合所有数据后，心导管检查法与压力减半时间法之间的相关性显著（r = 0.65；p < 0.001），心导管检查法与连续方程法之间的相关性也显著（r = 0.64；p < 0.001）。然而，这三种技术测量结果之间存在很大程度的变异性。PBMV前，心导管检查法与压力减半时间法测量MVA的平均差异为-0.2±0.4 cm²，心导管检查法与连续方程法之间为0.1±0.3 cm²。这种变异性在PBMV后更为明显：心导管检查法与压力减半时间法之间为-0.5±0.9 cm²，心导管检查法与连续方程法之间为0.4±0.6 cm²。尽管先前的研究表明心导管检查法与两种多普勒超声心动图方法测量的MVA之间具有良好的相关性，但这些研究涵盖了广泛的MVA范围。在我们对血流动力学显著的二尖瓣狭窄患者的研究中，心导管检查法与同时进行的多普勒超声心动图方法之间存在很大程度的变异性。通过任何方法计算得到的MVA都不应作为狭窄严重程度的唯一衡量指标。
