目的:目前关于经胸超声心动图(TTE)衍生的多普勒参数评估生物假体三尖瓣(BTV)功能障碍的实用性的信息有限。我们的研究旨在为常规收集的经胸多普勒参数建立精度和适当的参考范围,以评估BTV功能障碍。
方法:我们回顾性评估了100例接受TTE的BTV患者。基于重做手术确认或超过2次重复TTE或经食管超声心动图(TEE)检查,患者被分配到正常(n=61),反流(n=24),或狭窄(n=15)BTV组。进行单变量和多变量二元逻辑回归以确定检测BTV功能障碍的TTE多普勒参数。
结果:VTI比率(VTITV/VTILVOT)是检测BTV功能障碍的最准确的多普勒参数,>2.8的比率显示84.6%的敏感性和90.2%的特异性。VTI比值>3.2,平均梯度(MGTV)>6.2mmHg,压力半衰期>218ms检测到明显的BTV狭窄,灵敏度为100%,93.3%和93.3%,特异性为82.4%,75.3%和87.1%,分别。经过多变量分析,VTI比率>2.8(OR=9.00,95%CI=2.13-41.61,p=.003)和MGTV>5.1mmHg(OR=6.50,95%CI=1.69-27.78,p=.008)是BTV功能障碍的独立关联。有了这些截止值,确定了75.0%-92.2%的正常和62.5%-96.0%的功能失调的BTV。
结论:来自TTE的多普勒参数可以准确识别BTV功能障碍,特别是在VTI比率>2.8和MGTV>5.1mmHg的情况下,评估是否需要使用TEE进行额外测试。
OBJECTIVE: There is currently limited information on the utility of transthoracic echocardiography (TTE)-derived Doppler parameters for assessing bioprosthetic tricuspid valve (BTV) dysfunction. Our study aimed to establish the precision and appropriate reference ranges for routinely collected transthoracic Doppler parameters in the assessment of BTV dysfunction.
METHODS: We retrospectively evaluated 100 BTV patients who underwent TTE. Based on redo surgical confirmation or more than 2 repeat TTE or transesophageal echocardiography (TEE) examinations, patients were allocated to normal (n = 61), regurgitant (n = 24), or stenotic (n = 15) BTV group. Univariate and multivariate binary logistic regression were performed to identify TTE Doppler parameters that detected BTV dysfunction.
RESULTS: The VTI ratio (VTITV/VTILVOT) was the most accurate Doppler parameter for detecting BTV dysfunction, with a ratio of >2.8 showing 84.6% sensitivity and 90.2% specificity. VTI ratio > 3.2, mean gradient (MGTV) > 6.2 mmHg and pressure half-time > 218 ms detected significant BTV stenosis, with sensitivities of 100%, 93.3% and 93.3% and specificities of 82.4%, 75.3% and 87.1%, respectively. After multivariate analysis, the VTI ratio > 2.8 (OR = 9.00, 95% CI = 2.13-41.61, p = .003) and MGTV > 5.1 mmHg (OR = 6.50, 95% CI = 1.69-27.78, p = .008) were the independent associations of BTV dysfunction. With these cutoff values, 75.0%-92.2% of normal and 62.5%-96.0% of dysfunctional BTV were identified.
CONCLUSIONS: Doppler parameters from TTE can accurately identify BTV dysfunction, particularly with VTI ratio > 2.8 and MGTV > 5.1 mmHg, to assess the need for additional testing with TEE.