全身成像三维量化法评估二尖瓣反流严重程度的可行性及准确性

摘要

目的:探讨全身成像三维量化(GI3DQ)法测量的二尖瓣反流束体积(MRvol)评估二尖瓣反流(MR)严重程度的可行性及准确性.方法:93例MR患者根据二尖瓣反流束方向分为两组:中心性MR组41例,偏心性MR组52例.依据实时三维超声心动图(RT3DE)平面法测量MR的有效反流口面积(EROA)将MR患者分为轻度、中度、重度.GI3DQ法直接测量MRvol.结果:中心性MR组受试者工作特征(ROC)曲线分析示:GI3DQ法测量的MRvol>16.2 ml时,曲线下面积为0.93(P<0.0001),区分轻度MR和中度MR的敏感性为96.0%、特异性为70.0%;MRvol>44.5 ml时,曲线下面积为0.96(P<0.0001),区分中度MR和重度MR的敏感性为97.6%、特异性为91.7%.偏心性MR组ROC曲线分析示:MRvol>14.2 ml时,曲线下面积为0.77(P=0.0243),区分轻度MR和中度MR的敏感性为91.8%、特异性为62.5%;MRvol>40.5 ml时,曲线下面积为0.83(P<0.0001),区分中度MR和重度MR的敏感性为82.3%、特异性为77.9%.结论:以RT3DE平面法测量MR的EROA为参考标准,GI3DQ法直接测量MRvol可较为准确地评估MR的严重程度,尤其在中心性MR组,区分中度MR和重度MR时,拥有更高的敏感性和特异性.%To explore the feasibility and accuracy for evaluating mitral regurgitation (MR) severity with MR jet volume (MRvol) by means of general imaging three-dimensional quantification (GI3DQ). Methods: A total of 93 MR patients were divided into 2 groups: Central MR group, n=41 and Eccentric MR group, n=52. According to real-time three-dimensional echocardiography (RT3DE) examined planimetry of effective regurgitation orifice area (EROA), the patients were graded into mild MR, moderate MR and severe MR. MRvol was directly measured by GI3DQ. Results: In Central MR group, ROC analysis showed that as GI3DQ measured MRvol>16.2 ml, AUC=0.93, P<0.0001, the sensitivity and specificity for distinguishing mild MR and moderate MR were 96.0% and 70.0%respectively; as MRvol>44.5 ml, AUC=0.96, P<0.0001, the sensitivity and specificity for distinguishing moderate MR and severe MR were 97.6% and 91.7% respectively. In Eccentric MR group, as MRvol>14.2 ml, AUC=0.77, P=0.0243, the sensitivity and specificity for differentiating mild MR and moderate MR were 91.8% and 62.5% respectively; as MRvol>40.5 ml, AUC=0.83, P<0.0001, the sensitivity and specificity for differentiating moderate MR and severe MR were 82.3% and 77.9% respectively. Conclusion: Taking RT3DE examined EROA as reference, GI3DQ directly measured MRvol could more accurately assess MR severity especially in patients with central MR, it may distinguish moderate MR and severe MR with the higher sensitivity and specificity.