经食管实时三维超声心动图测量主动脉瓣环与二尖瓣环间夹角

doi:10.3877/cma.j.issn.1672-6448.2017.11.014

目的

采用经食管实时三维超声心动图（RT3D-TEE）重建主动脉瓣环与二尖瓣环，探讨正常主动脉瓣环与二尖瓣环间夹角（AMA）随心动周期的变化规律。

方法

选取2016年1至3月在四川大学华西医院行RT3D-TEE检查的19例患者，于左心室长轴观采集3个心动周期包含完整主动脉瓣环、二尖瓣环的三维动态超声图像。采用Acuson-4.0 eSie Valves分析软件获得AMA心动周期的动态值。采用配对t检验比较AMA收缩期和舒张期平均值差异。采用Bland-Altman分析法分析观察者内与观察者应用RT3D-TEE测量AMA的一致性。

结果

本组19例患者AMA收缩期和舒张期平均值分别为（111.35^°±10.68^°）和（118.14^°±10.89^°）。AMA舒张期平均值大于收缩期平均值，且差异有统计学意义（t=-2.56，P<0.05），说明AMA在收缩期减小，舒张期增大。Bland-Altman分析结果显示，观察者内与观察者应用RT3D-TEE测量AMA具有较好的一致性，95%置信区间分别为（-6.6^°，5.6^°）和（-7.1^°，8.7^°）（r=0.80，P=0.0055；r=0.69，P=0.0283）。

结论

RT3D-TEE能快速定量分析AMA随心动周期的变化，且测量一致性较好，可为临床主动脉瓣、二尖瓣的修复及置换手术提供参考依据。

关键词: 超声心动描记术，经食管, 主动脉瓣, 二尖瓣

Objective

To quantitatively investigate the dynamic changes of aortic-mitral angle (AMA) using real-time three-dimensional transesophageal echocardiography (RT3D-TEE) in the whole cardiac cycle.

Methods

RT3D-TEE was performed in 19 patients in West China Hospital of Sichuan University in January to March 2016. Custom software of Acuson-4.0 eSie Valves was used to detect and track the mitral and aortic annuli in 3D space throughout the cardiac cycle, allowing automated measurement of changes in AMA. The dynamic changes of AMA during a whole cardiac cycle were observed using paired t test. And the inter-observer and intra-observer variability were evaluated by Bland-Altman analysis.

Results

AMA was smaller in systole than in diastole (111.35^°±10.68^° vs. 118.14^°±10.89^°, t=-2.56, P<0.05). The inter-observer and intra-observer repeatability were good, and the 95% confidence interval was (-6.6^°, 5.6^°) and (-7.1^°, 8.7^°) (r=0.80, P=0.0055 and r=0.69, P=0.0283).

Conclusions

Quantitative measurement of the AMA by RT3D-TEE is feasible, with good inter-observer and intra-observer agreement. These parameters may contribute to the implementation of the aortic or mitral valves replacement.

Key words: Echocardiography, transesophageal, Aortic-mitral angle, Aortic valve, Mitral valve

图5 正常主动脉瓣环与二尖瓣环间夹角随心动周期的动态变化曲线：0点为舒张早期，可见随心动周期正常主动脉瓣环与二尖瓣环间夹角逐渐增大，在收缩期正常主动脉瓣环与二尖瓣环间夹角减小

图6，7 观察者内（图6）与观察者间（图7）应用经食管实时三维超声心动图测量正常主动脉瓣环与二尖瓣环间夹角一致性的Bland-Altman分析图。观察者内与观察者间应用经食管实时三维超声心动图测量正常主动脉瓣环与二尖瓣环间夹角具有较好的一致性，95%置信区间分别为（-6.6^°，5.6^°）和（-7.1^°，8.7^°）（r=0.80，P=0.0055；r=0.69，P=0.0283）

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摘要

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Quantitative measurement of the aortic-mitral angle by real-time three-dimensional transesophageal echocardiography

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Quantitative measurement of the aortic-mitral angle by real-time three-dimensional transesophageal echocardiography