摘要
目的:分析三尖瓣反流量(regurgitant volume,RVol)、有效反流口面积(effective regurgitant orifice area,EROA)和反流分数(regurgitant fraction,RF)之间的相关性及其与血流动力学结局的相关性和对重度三尖瓣反流的诊断效力。方法:选择2018年7月至2019年7月于复旦大学附属中山医院心外科行孤立三尖瓣手术或经右房-房间隔入路的二尖瓣合并三尖瓣手术的三尖瓣反流患者,进行经胸二维超声心动图(two-dimensional echocardiography,2DE)及右心室三维超声心动图(three-dimensional echocardiography,3DE)检查。计算RVol、EROA、RF。三尖瓣反流严重程度分级从患者手术记录中获取。结果:最终纳入统计148例患者。EROA与RVol呈线性相关(r=0.93,P<0.001);RF与EROA和RVol均呈对数相关(r=0.86,P<0.001;r=0.86,P<0.001),当RF>50%时,其与EROA和RVol的关系均趋于平缓。EROA和RVol与右心室舒张末容积指数相关程度(r=0.74,P<0.001;r=0.66,P<0.001)高于RF(r=0.47,P<0.001)。EROA与RVol诊断三尖瓣反流的曲线下面积(area under the curve,AUC)相似(Z=0.885,P=0.3761),而RF的AUC显著低于EROA与RVol(Z=2.271,P=0.0231;Z=2.731,P=0.0063)。多元线性回归模型中,RF受到心率、心输出量、EROA、右心室舒张末容积指数、右心室射血分数和肺动脉收缩压的多重影响(R2=0.86,P<0.001)。结论:当RF超过50%时,EROA和RVol较RF能更精确地反映三尖瓣反流的严重程度;EROA和RVol较RF与三尖瓣反流的血流动力学结局相关性更强,对重度三尖瓣反流的诊断效力更高。
Objective:To analyze the correlation of regurgitant volume(RVol),effective regurgitant orifice area(EROA),and regurgitant fraction(RF)in tricuspid regurgitation(TR)quantitation,their relation to hemodynamic consequences,and their diagnostic power to determine severe TR.Methods:TR patients who underwent either isolated tricuspid surgery or combined mitral and tricuspid surgery thorough inter-atrial groove approach in Zhongshan Hospital,Fudan University from July 2018 to July 2019 were prospectively included.2D and right-ventricle-focused 3D transthoracic echocardiography were performed.RVol,EROA,and RF were calculated.TR grades were transcribed from surgical records.Results:Totally,148 patients were included in the final analysis.EROA and RVol were linearly correlated(r=0.93,P<0.001)while RF was logarithmically correlated with EROA and RVol(r=0.86,P<0.001;r=0.86,P<0.001),with a flattened trend when RF exceeded 50%.EROA and RVol correlated more closely with right ventricular end-diastolic volume index(r=0.74,P<0.001;r=0.66,P<0.001)than did RF(r=0.47,P<0.001).Receiver operator characteristic analysis revealed insignificant difference in area under the curve(AUC)between RVol and EROA(Z=0.885,P=0.3761),while AUC of RF was significantly lower than either RVol or EROA(Z=2.271,P=0.0231;Z=2.731,P=0.0063).Multiple linear regression analysis showed that RF was affected by heart rate,cardiac output,EROA,right ventricular end-diastolic volume index,RVEF,and systolic pulmonary arterial pressure(R^(2)=0.86,P<0.001).Conclusions:EROA and RVol could more accurately show the severity degree of TR when RF exceeds 50%,and are more closely related to the hemodynamic consequences of TR and have higher diagnostic power for severe TR than RF.
作者
刘宇
陈蓓绮
潘翠珍
董丽莉
舒先红
LIU Yü;CHEN Bei-qi;PAN Cui-zhen;DONG Li-li;SHU Xian-hong(Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China)
出处
《中国临床医学》
2021年第2期216-223,共8页
Chinese Journal of Clinical Medicine
基金
国家自然科学基金面上项目(81771837)
国家重大疾病多学科合作诊疗能力建设项目-中山医院心脏瓣膜疾病多学科合作诊疗中心(w2019-030),上海市医学引导类项目(17411962400).
关键词
三尖瓣反流
容量法
有效反流口
反流分数
tricuspid regurgitation
volumetric method
effective regurgitant orifice
regurgitant fraction
