Tribouilloy C M, Enriquez-Sarano M, Fett S L, Bailey K R, Seward J B, Tajik A J
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 1998 Oct;32(4):1032-9. doi: 10.1016/s0735-1097(98)00356-8.
We sought to determine the reliability of the proximal isovelocity surface area (PISA) method for calculation of effective regurgitant orifice (ERO) of aortic regurgitation (AR).
The ERO area can be calculated by the PISA method, but this method has not been validated in AR.
ERO calculation by the PISA method was undertaken prospectively in 71 consecutive patients with isolated AR and achieved in 64 and compared with two simultaneous reference methods (quantitative Doppler and quantitative two-dimensional echocardiography). In addition, this method was compared with angiography in 12 patients, with surgical assessment in 18 patients and with ventricular volumes in all patients.
Good correlations between PISA and reference methods were obtained (both r=0.90, both p < 0.0001), but a trend toward underestimation of the ERO by the PISA method was noted (24+/-19 vs. 26+/-22 mm2 and 27+/-23 mm2, respectively, both p=0.04). However, this trend was confined to five patients with an obtuse flow convergence angle (>220 degrees), and on multivariate analysis this variable was the only independent determinant of underestimation of the ERO. In contrast, in 59 patients with a flat flow convergence (< or =220 degrees ), the PISA method, in comparison with reference methods, showed excellent correlations, with a narrow standard error of the estimate (r=0.95, SEE 5.4 mm2, and r=0.95, SEE 5.8 mm2; all p < 0.0001) and no trend toward underestimation (22+/-18 vs. 23+/-16 mm2, p=0.44, and vs. 23+/-18 mm2, p=0.34).
In patients with AR, the PISA method can be used to measure the ERO with reasonable feasibility. Underestimation of the ERO by PISA may occur in patients with an obtuse flow convergence angle. However, in most patients with appropriate flow convergence, PISA provides reliable measurement of the ERO of AR.
我们旨在确定用近端等速表面积（PISA）法计算主动脉瓣反流（AR）有效反流口面积（ERO）的可靠性。
ERO面积可通过PISA法计算，但该方法尚未在AR中得到验证。
对71例连续性单纯AR患者前瞻性地采用PISA法计算ERO，并成功计算出64例患者的ERO，将其与两种同步参考方法（定量多普勒和定量二维超声心动图）进行比较。此外，还将该方法与12例患者的血管造影、18例患者的手术评估以及所有患者的心室容积进行了比较。
PISA与参考方法之间具有良好的相关性（r均为0.90，p均<0.0001），但注意到PISA法有低估ERO的趋势（分别为24±19 vs. 26±22 mm²和27±23 mm²，p均=0.04）。然而，这种趋势仅限于5例血流会聚角为钝角（>220度）的患者，多因素分析显示该变量是ERO低估的唯一独立决定因素。相比之下，在59例血流会聚平坦（≤220度）的患者中，与参考方法相比，PISA法显示出极佳的相关性，估计标准误差较窄（r = 0.95，SEE 5.4 mm²，以及r = 0.95，SEE 5.8 mm²；所有p < 0.0001）且无低估趋势（22±18 vs. 23±16 mm²，p = 0.44，以及与23±18 mm²相比，p = 0.34）。
在AR患者中，PISA法可用于测量ERO，具有合理的可行性。血流会聚角为钝角的患者中PISA法可能会低估ERO。然而，在大多数血流会聚合适的患者中，PISA可提供可靠的AR的ERO测量值。
