Langholz D, Mackin W J, Wallis D E, Jacobs W R, Scanlon P J, Louie E K
Division of Cardiology, Loyola University Medical Center, Maywood, IL 60153, USA.
Am Heart J. 1998 Feb;135(2 Pt 1):197-206. doi: 10.1016/s0002-8703(98)70082-1.
Though qualitative transthoracic echocardiographic criteria for abnormal systolic leaflet motion are widely accepted as diagnostic characteristics of mitral valve prolapse, transesophageal echocardiographic criteria have not been evaluated against such a standard. Because transesophageal imaging planes are not identical to transthoracic imaging planes, validation of transesophageal echocardiographic criteria for mitral valve prolapse is needed. Eleven patients with mitral valve prolapse (based on physical findings and transthoracic echocardiographic criteria) and 11 healthy persons underwent prospective transesophageal echocardiography in two orthogonal imaging planes. Measurements of maximal leaflet displacement superior to the annular hinge points and mitral prolapse area subtended by the displaced mitral leaflets and the chord connecting the annular hinge points were performed in triplicate and averaged by a blinded observer. Though maximal systolic leaflet displacement was greater among patients with mitral valve prolapse than healthy subjects for both the transesophageal four-chamber (0.66+/-0.39 cm versus 0.05+/-0.11 cm, p < 0.001) and two chamber views (0.57+/-0.44 cm versus 0.20+/-0.25 cm, p < 0.04), no unique value differentiated patients with from those without mitral valve prolapse. Mitral prolapse area was greater for patients with mitral valve prolapse than for healthy subjects in both transesophageal four-chamber (1.23+/-1.18 cm2 versus 0.03+/-0.06 cm2, p < 0.02) and two-chamber views (1.73+/-1.65 cm2 versus 0.21+/-0.31 cm2, p < 0.02). Whereas a mitral prolapse area of 0.20 cm2 uniquely differentiated patients with from those without mitral valve prolapse in the four-chamber view, data overlap prevented determination of a similar diagnostic criterion for the two-chamber view. The difficulty in defining quantitative transesophageal echocardiographic criteria for mitral valve prolapse based on leaflet displacement alone suggested that the simple qualitative observation of leaflet displacement above the annular hinge points should not be used as a defining morphologic criterion for mitral valve prolapse.
尽管经胸超声心动图对收缩期瓣叶运动异常的定性标准被广泛接受为二尖瓣脱垂的诊断特征，但经食管超声心动图标准尚未依据这样的标准进行评估。由于经食管成像平面与经胸成像平面不同，因此需要对经食管超声心动图诊断二尖瓣脱垂的标准进行验证。11例二尖瓣脱垂患者（基于体格检查和经胸超声心动图标准）和11名健康人在两个相互垂直的成像平面接受了前瞻性经食管超声心动图检查。对瓣叶在瓣环铰链点上方的最大位移以及由移位的二尖瓣瓣叶和连接瓣环铰链点的腱索所形成的二尖瓣脱垂面积进行了三次测量，并由一名不知情的观察者求平均值。尽管在经食管四腔心切面（0.66±0.39cm对0.05±0.11cm，p<0.001）和两腔心切面（0.57±0.44cm对0.20±0.25cm，p<0.04）中，二尖瓣脱垂患者的最大收缩期瓣叶位移均大于健康受试者，但没有单一数值能够区分二尖瓣脱垂患者和非二尖瓣脱垂患者。在经食管四腔心切面（1.23±1.18cm²对0.03±0.06cm²，p<0.02）和两腔心切面（1.73±1.65cm²对0.21±0.31cm²，p<0.02）中，二尖瓣脱垂患者的二尖瓣脱垂面积均大于健康受试者。在四腔心切面中，二尖瓣脱垂面积为0.20cm²可唯一区分二尖瓣脱垂患者和非二尖瓣脱垂患者，但数据重叠使得无法确定两腔心切面的类似诊断标准。仅基于瓣叶位移来定义经食管超声心动图诊断二尖瓣脱垂的定量标准存在困难，这表明简单地定性观察瓣叶在瓣环铰链点上方的位移不应被用作二尖瓣脱垂的形态学定义标准。
