应用三维彩色多普勒超声对扩张型心肌病与二尖瓣脱垂患者二尖瓣反流的评价

目的：应用三维彩色多普勒超声（3D-CDE）直视下描绘二尖瓣反流（MR）的反流口面积（ROA）,探讨3D-CDE对评价不同发病机制MR方面的临床应用.方法：选取不同程度MR的二尖瓣脱垂（MVP）和扩张型心肌病（DCM）患者各30例,观察两个病例组反流口的形状及PISA的三维空间形态.用ASE推荐的二维综合方法对这60例患者的MR程度进行划分,分别用3D-ROA法和2D-PISA法测量每位患者的ROA,并对两种方法进行相关性分析.结果：两个病例组反流口的形状及PISA的三维空间形态有不同.两个病例组3D-ROA法和2D-PISA法所测结果均具有相关性.DCM组两种方法相关性较好（r=0.783,Y=0.661x-0.45,P＜0.001）,MVP组两种方法相关性良好,大于DCM组（r=0.924,Y=1.172x-0.057,P＜0.001）.DCM组2D-PISA法比3D-ROA法低估了大约26％.结论：3D-ROA法与传统二维方法相比可以更直观、更准确的评价功能性MR.

Evaluation of the degree of mitral regurgitation in dilated cardiomyopathy and mitral valve prolapse using three-dimensional color Doppler echocardiography

Objective：To investigate the value of three-dimensional color Doppler echocardiography（3D-CDE） in measuring the regurgitant orifice area（ROA） of mitral regurgitation（MR） in an en-face view to estimate the MR degree of different regurgitation mechanism.Methods：We selected 30 patients of mitral valve prolapse （MVP） and 30 patients of dilated cardiomyopathy （DCM） with different regurgitation degree.The 2D integrative method recommended by the ASE was used as the reference standard for MR grading in the 60 patients.Each patient＇s ROA by 3D-ROA method and 2D-PISA method were measured respectively,and the correlation of the two methods was analysed.Results：The shape of the regurgitation orifice and the three-dimensional morphology of PISA was very different.There were correlations between the 2D-PISA and 3D-ROA method in the DCM group（r=0.783,Y=0.661x-0.45,P＜0.001）.However,in the MVP group,the relationship between the values by the 2D-PISA and 3D-ROA method was close to the hne of identity （r=0.924,Y=1.172x-0.057,P＜0.001）.The 2D-PISA method underestimated the 3D-ROA by 26％ in the DCM group.Conclusion：Compared with traditional 2D methods,3D-ROA method can be more intuitive,more accurate in evaluating functional MR.