QUANTIFICATION OF MITRAL REGURGITATION WITH THE PROXIMAL FLOW CONVERGENCE METHOD - A CLINICAL-STUDY
QUANTIFICATION OF MITRAL REGURGITATION WITH THE PROXIMAL FLOW CONVERGENCE METHOD - A CLINICAL-STUDY
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DOI：
10.1016/0002-8703(92)90414-q
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发表时间：
1992-11-01
影响因子：
4.8
通讯作者：
THOMAS, JD
中科院分区：
文献类型：
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作者：
RIVERA, JM;VANDERVOORT, PM;THOMAS, JD
瓣膜关闭不全的准确定量仍然是临床心脏病学的一个重要目标。以前已经表明，当使用彩色血流多普勒成像时，简单地测量表观射流大小与返流流量和返流分数没有密切的关系。最近，近端血流会聚方法被提出通过分析返流病变近端的会聚流场来量化瓣膜返流。流量Q可计算为Q=2pir2v(A)，其中v(A)是距孔口距离r处的混叠速度。对54例二尖瓣返流患者(窦性心律43例，房颤11例)进行二尖瓣返流半定量评价，用近端血流会聚法计算返流每搏量、返流速度和返流分数，并与多普勒二维超声心动图测值进行比较。近端血流会聚法计算的返流每搏输出量(V(R))与多普勒二维法计算的返流每搏输出量(V(R))具有非常密切的相关性，r=0.93(y=0.95x+0.55)，DELTAV(R)=-0.3+/-4.0 cm~3。两种方法计算的返流流量(Q)具有相似的相关性：r=0.93(y=0.95x+54)，DELTAQ=-34+/-284cm3/min。两种技术计算的返流分数相关系数分别为r=0.89(y=0.98x+0.006)和DELTARF=-0.005+/-0.06。窦性心律患者组的所有相关性均略好于房颤患者组。这项研究表明，近端血流会聚法是一种准确和可重复性的技术，可以定量至少有轻度二尖瓣反流的患者的二尖瓣反流。这种方法比多普勒超声心动图方法简单，耗时少。虽然这种方法的进一步改进是可以预期的，但基于近端流场的简单半球对称性假设的流动计算显示出很好的结果，似乎适合于目前的临床应用。
Accurate quantitation of valvular incompetence remains an important goal in clinical cardiology. It has been shown previously that when color flow Doppler mapping is used, simple measurements of apparent jet size do not correlate closely with regurgitant flow rate and regurgitant fraction. Recently the proximal flow convergence method has been proposed to quantify valvular regurgitation by analysis of the converging flow field proximal to a regurgitant lesion. Flow rate Q can be calculated as Q = 2pir2v(a) where v(a) is the aliasing velocity at a distance r from the orifice. In 54 patients (43 with sinus rhythm and 11 with atrial fibrillation) who had at least mild mitral regurgitation according to semiquantitative assessment, regurgitant stroke volume, regurgitant flow rate, and regurgitant fraction were calculated with the proximal flow convergence method and compared with values that were obtained by the Doppler two-dimensional echocardiographic method. Regurgitant stroke volumes (V(r)) as calculated by the proximal flow convergence method correlated very closely with values that were obtained by the Doppler two-dimensional method, with r = 0.93 (y = 0.95x + 0.55) and DELTAV(r) = -0.3 +/- 4.0 cm3. Regurgitant flow rates (Q) as calculated by both methods showed a similar correlation: r = 0.93 (y = 0.95x + 54) and DELTAQ = -34 +/- 284 cm3/min. The correlation for regurgitant fraction (RF) as calculated by both techniques showed r = 0.89 (y = 0.98x + 0.006) and DELTARF = -0.005 +/- 0.06. All correlations were slightly better for the group of patients with sinus rhythm than for the study group of patients with atrial fibrillation. This study demonstrates that the proximal flow convergence method is an accurate and reproducible technique to quantify mitral regurgitation in patients with at least mild mitral regurgitation. This approach is easy and less time-consuming than the Doppler echocardiographic method. Although future refinements of this method are to be expected, flow calculations that are based on the assumption of simple hemispheric symmetry of the proximal flow field show excellent results and appear to be suitable for clinical application at present.