Hall S A, Brickner M E, Willett D L, Irani W N, Afridi I, Grayburn P A
Department of Medicine, University of Texas Southwestern, Dallas 75235-9047, USA.
Circulation. 1997 Feb 4;95(3):636-42. doi: 10.1161/01.cir.95.3.636.
Although Doppler color flow mapping is widely used to assess the severity of mitral regurgitation (MR), a simple, accurate, and quantitative marker of MR by color flow mapping remains elusive. We hypothesized that vena contracta width by color flow mapping would accurately predict the severity of MR.
We studied 80 patients with MR. Vena contracta width was measured in multiple views with zoom mode and nonstandard angulation to optimize its visualization. Flow volumes across the left ventricular outflow tract and mitral annulus were calculated by pulsed-Doppler technique to determine regurgitant volume. Effective regurgitant orifice area was calculated by dividing the regurgitant volume by the continuous-wave Doppler velocity-time integral of the MR jet. The cause of MR was ischemia in 24, dilated cardiomyopathy in 34 mitral valve prolapse in 12, endocarditis in 2, rheumatic disease in 2, mitral annular calcification in 1, and uncertain in 5. Regurgitant volumes ranged from 2 to 191 mL. Regurgitant orifice area ranged from 0.01 to 1.47 cm2. Single-plane vena contracta width from the parasternal long-axis view correlated well with regurgitant volume (r = .85, SEE = 20 mL) and regurgitant orifice area (r = .86, SEE = 0.15 cm2). Biplane vena contracta width from apical views correlated well with regurgitant volume (r = .85, SEE = 19 mL) and regurgitant orifice area (r = .88, SEE = 0.14 cm2). A biplane vena contracta width > or = 0.5 cm was always associated with a regurgitant volume > 60 mL and a regurgitant orifice area > 0.4 cm2. A biplane vena contracta width < or = 0.3 cm predicted a regurgitant volume < 60 mL and a regurgitant orifice area < 0.4 cm2 in 24 of 29 patients. No other parameter, including jet area, left atrial size, pulmonary flow reversal, or semiquantitative MR grade, correlated significantly with regurgitant volume or regurgitant orifice area in a multivariate analysis.
Our results demonstrate that careful color flow mapping of the vena contracta of the MR jet provides a simple quantitative assessment of MR that correlates well with quantitative Doppler techniques.
尽管多普勒彩色血流图被广泛用于评估二尖瓣反流（MR）的严重程度，但通过彩色血流图获得一种简单、准确且定量的MR标志物仍未实现。我们假设通过彩色血流图测量的反流束缩流颈宽度能够准确预测MR的严重程度。
我们研究了80例MR患者。采用放大模式和非标准角度在多个视图中测量反流束缩流颈宽度，以优化其可视化。通过脉冲多普勒技术计算左心室流出道和二尖瓣环处的血流量，以确定反流容积。有效反流口面积通过将反流容积除以MR射流的连续波多普勒速度时间积分来计算。MR的病因包括缺血性24例、扩张型心肌病34例、二尖瓣脱垂12例、心内膜炎2例、风湿性疾病2例、二尖瓣环钙化1例、病因不明5例。反流容积范围为2至191 mL。反流口面积范围为0.01至1.47 cm²。胸骨旁长轴视图的单平面反流束缩流颈宽度与反流容积（r = 0.85，标准误 = 20 mL）和反流口面积（r = 0.86，标准误 = 0.15 cm²）相关性良好。心尖视图的双平面反流束缩流颈宽度与反流容积（r = 0.85，标准误 = 19 mL）和反流口面积（r = 0.88，标准误 = 0.14 cm²）相关性良好。双平面反流束缩流颈宽度≥0.5 cm总是与反流容积>60 mL和反流口面积>0.4 cm²相关。双平面反流束缩流颈宽度≤0.3 cm在29例患者中的24例中预测反流容积<60 mL和反流口面积<0.4 cm²。在多变量分析中，包括射流面积、左心房大小、肺血流逆转或半定量MR分级在内的其他参数与反流容积或反流口面积均无显著相关性。
我们的结果表明，仔细绘制MR射流反流束缩流颈的彩色血流图可提供一种简单的MR定量评估方法，与定量多普勒技术相关性良好。
