实时三维经食管超声心动图定量分析主动脉瓣反流患者主动脉瓣叶解剖结构

摘要

目的 应用实时三维经食管超声心动图(RT-3D-TEE)定量分析主动脉瓣反流(AR)患者主动脉瓣叶解剖参数,筛选显著影响AR的参数.方法 选取AR患者32例作为反流组,无AR患者20例作为对照组,应用RT-3D-TEE采集两组患者的图像并进行脱机分析,分别测得主动脉瓣左冠瓣、右冠瓣、无冠瓣三个瓣叶的12个参数:瓣叶游离缘长度(LL、RL、NL)、瓣叶高度(LH、RH、NH)、瓣叶游离缘长度/高度比值(LRa、RRa、NRa)、瓣尖到铰链平面距离(LTH、RTH、NTH).将两组参数进行统计学分析,纳入Logistic回归模型,对进入logistic回归的参数绘制ROC曲线.结果 ①反流组的LL、RL、NL、RH、LRa、NRa、RRa、RTH均较对照组增大(P＜0.05),其余参数两组间差异无统计学意义(P＞0.05);②Logistic回归模型逐步筛选显著影响AR的因素,筛选出RL和RTH对AR有显著影响,P值分别为0.001、0.011;③ROC曲线分析显示RL和RTH曲线下面积分别为0.811、0.605.结论 瓣叶游离缘长度、瓣叶游离缘长度/高度比值的改变不均衡,右冠瓣各参数变化显著,是导致AR的重要因素.%Objective To quantitatively analysis the aortic valve leaf anatomical characteristics in aortic regurgitation(AR) patients by real-time three-dimensional transesophageal echocardiography (RT-3D-TEE),and screening the parameters which significantly affect AR to further reveal the mechanism of AR.Methods 32 patients with AR were enrolled as AR group and 20 cases of non-AR people were involved as control group.RT-3D-TEE was using to collect images in two groups and offline analysis was performed.4 sets of parameters of the aortic valves(left coronary valve,right coronary valve,and non-coronary valve):leaflet edge length(LL,RL,NL),leaflet height (LH,RH,N H),leaflet length/height ratio (LRa,RRa,NRa),leaflet tip plane distance(LTH,RTH,NTH) were acquired.Parameters of two groups were compared,and the parameters were incorporated into the logistic regression model,then the ROC curves were obtained.Results ①Compared with the control group,LL,RL,NL,RH,LRa,NRa,RRa in AR group increased (P ＜ 0.05),while the rest parameters had no statistical differences (P ＞0.05).②Multivariable logistic regression model gradually screening of the significant factors influencing the reflux,and as a result RL and RTH had significant influence on AR,P values were 0.001,0.011.③The ROC curve analysis showed that the area of RL or RTH curve were both greater than 0.5,which were 0.811 and 0.605 respectively.Conclusions The free edge length and free edge length/height ratio have changed unbalanced.Furthermore,right coronary valve parameters changed significantly,and this might be one of the possible mechanism of AR.