Bernard Y, Meneveau N, Vuillemenot A, Magnin D, Anguenot T, Schiele F, Bassand J P
Cardiology Department, Saint-Jacques University Hospital, Besançon, France.
Heart. 1997 Jul;78(1):68-73. doi: 10.1136/hrt.78.1.68.
To assess the reliability of aortic valve area planimetry by multiplane transoesophageal echocardiography (TOE) in aortic stenosis.
Study of the diagnostic value of aortic valve area planimetry using multiplane TOE, compared with catheterisation and the continuity equation, both being considered as criterion standards.
University hospital.
49 consecutive patients (29 male, 20 female, aged 44 to 82 years, average 66.6 (SD 8.5)), referred for haemodynamic evaluation of an aortic stenosis, were enrolled in a prospective study. From this sample, 37 patients were eligible for the final analysis.
Transthoracic and multiplane transoesophageal echocardiograms were performed within 24 hours before catheterisation. At transthoracic echo, aortic valve area was calculated by the continuity equation. At TOE, the image of the aortic valve opening was obtained with a 30-65 degrees rotation of the transducer. Numerical dynamic images were stored on optical discs for off-line analysis and were reviewed by two blinded observers. Catheterisation was performed in all cases and aortic valve area was calculated by the Gorlin formula.
Feasibility of the method was 92% (48/52). The agreement between aortic valve area measured at TOE (mean 0.88 (SD 0.35) cm2) and at catheterisation (0.79 (0.24) cm2) was very poor. The same discrepancies were found between TOE and the continuity equation (0.72 (0.26) cm2). TOE planimetry overestimated aortic valve area determined by the two other methods. Predictive positive and negative values of planimetry to detect aortic valve area < 0.75 cm2 were 62% (10/16) and 43% (9/21) respectively.
Planimetry of aortic valve area by TOE is difficult and less accurate than the continuity equation for assessing the severity of aortic stenosis.
评估多平面经食管超声心动图（TOE）测量主动脉瓣狭窄时主动脉瓣面积的可靠性。
研究多平面TOE测量主动脉瓣面积的诊断价值，并与心导管检查及连续方程法进行比较，后两者均被视为标准方法。
大学医院。
49例连续患者（男性29例，女性20例，年龄44至82岁，平均66.6（标准差8.5）岁），因主动脉瓣狭窄接受血流动力学评估，纳入一项前瞻性研究。该样本中，37例患者符合最终分析条件。
在导管插入术前24小时内进行经胸和多平面经食管超声心动图检查。经胸超声心动图检查时，通过连续方程计算主动脉瓣面积。TOE检查时，探头旋转30 - 65度获取主动脉瓣开放图像。数字动态图像存储在光盘上用于离线分析，由两名不知情的观察者进行评估。所有病例均进行了导管插入术，并通过戈林公式计算主动脉瓣面积。
该方法的可行性为92%（48/52）。TOE测量的主动脉瓣面积（平均0.88（标准差0.35）cm²）与导管插入术测量值（0.79（0.24）cm²）之间的一致性非常差。TOE与连续方程法之间也存在同样的差异（0.72（0.26）cm²）。TOE平面测量法高估了通过其他两种方法测定的主动脉瓣面积。平面测量法检测主动脉瓣面积<0.75 cm²的预测阳性值和阴性值分别为62%（10/16）和43%（9/21）。
对于评估主动脉瓣狭窄的严重程度，TOE测量主动脉瓣面积的方法难度较大且准确性低于连续方程法。
