| 摘要: |
| 目的 探讨经食管三维探头xPlane（Three-dimensional Transesophageal echocardiography-xPlane, 3D-TEE-xPlane）成像在评估二尖瓣脱垂部位和程度方面的价值。方法 选取在我院接受二尖瓣置换或成形术的二尖瓣脱垂患者92例，术前均行标准经胸二维超声心动图（Two-dimensional Transthoracic echocardiography，2D-TTE）和3D-TEE-xPlane超声心动图检查，以外科手术探查结果为金标准，对比分析2D-TTE与3D-TEE-xPlane检查在评估二尖瓣脱垂部位的敏感度、特异度、准确率、阳性预测值、阴性预测值，一致性检验采用Kappa检验。结果 与2D-TTE相比，3D-TEE-xPlane识别A1、A2、P1、P2区二尖瓣脱垂的敏感度均提高（64.7% vs. 94.1%、73.7% vs. 100%、64.7% vs. 94.1%、82.2% vs. 97.8%）；识别A1、A2、A3、P1、P2及P3区二尖瓣脱垂的特异度均提高（90.7% vs. 98.7%、90.4% vs. 98.6%、90.9% vs. 98.7%、92.0% vs. 100%、89.4% vs. 100%、87.7 vs. 98.5%）；识别A1、A2、A3、P1、P2及P3区二尖瓣脱垂的准确率均提高（85.9% vs. 97.8%、87.0% vs. 98.9%、87.0% vs. 97.8%、87.0% vs. 98.9%、85.9% vs. 98.9%、84.8% vs. 97.8%）；识别A1、A2、A3、P1、P2及P3区二尖瓣脱垂的阳性预测值均提高（61.1% vs. 94.1%、66.7% vs. 95.0%、58.8% vs. 93.3%、64.7% vs. 100.0%、81.1% vs. 100.0%、72.4% vs. 96.3%）；识别A2及P2区二尖瓣脱垂的阴性预测值均提高（93.0% vs. 100%、84.0% vs. 97.9%），差异均有统计学意义（均P＜0.05）。与术中手术探查结果比较，2D-TTE识别A1、A3、P1区二尖瓣脱垂的一致性中等（A1=0.541, A3=0.546, P1=0.567）；识别其余二尖瓣各脱垂小叶的一致性较强（A2=0.617, P2=0.717, P3=0.641）；3D-TEE-xPlane识别二尖瓣各脱垂小叶的一致性均强（A1=0.928, A2=0.967, A3=0.920,P1=0.963,P2=0.978, P3=0.948）（均P＜0.05）。结论 3D-TEE-xPlane成像是一种准确、易于使用且易于解释的成像方式，可更加准确地评估二尖瓣脱垂的部位。 |
| 关键词: 超声心动描记术，二维，经胸 三维，经食管 xPlane 二尖瓣脱垂 |
| DOI： |
| 投稿时间：2021-11-30修订日期：2022-03-18 |
| 基金项目:武汉市卫生健康委员会医学科研项目青年重点项目(WX19Q13)、湖北省卫生健康委联合基金立项项目（WJ2019H360） |
|
| Assessing the Location of Mitral Valve Prolapse by Three-dimensional Transesophageal Echocardiography with xPlane Imaging Technology |
| Cheng Guan,He Yafeng |
| () |
| Abstract: |
| Objective The present study aims to evaluate the value of three-dimensional transesophageal echocardiography with xPlane imaging technology（3D-TEE-xPlane） in the location and grading of mitral valve prolapse.Methods A total of 92 patients with mitral valve prolapse who had underwent mitral valve replacement or plasty at Wuhan Asia Heart Hospital from January 2018 to January 2021 were selected.All patients underwent standard two-dimensional transthoracic echocardiography（2D-TTE） and 3D-TEE-xPlane echocardiography.With surgical exploration as the gold standard，comparative analysis of the sensitivity，specificity，accuracy，positive and negative predictive rate of 2D-TTE and 3D-TEE-xPlane in assessing the location of mitral valve prolapse.Results Compared with 2D-TTE，the sensitivity of 3D-TEE-xPlane in A1，A2，P1，P2 area prolapse recognition is improved（64.7% vs 94.1%，73.7% vs 100%，64.7% vs 94.1%，82.2% vs 97.8%），the specificity of 3D-TEE-xPlane in A1，A2，A3，P1，P2 and P3 area prolapse recognition is improved（90.7% vs 98.7%，90.4% vs 98.6%，90.9% vs 98.7%，92.0% vs 100%，89.4% vs 100%，87.7 vs 98.5%），the accuracy of 3D-TEE-xPlane in A1，A2，A3，P1，P2 and P3 area prolapse recognition is also improved（85.9% vs 97.8%，87.0% vs 98.9%，87.0% vs 97.8%，87.0% vs 98.9%，85.9% vs 98.9%，84.8% vs 97.8%），the positive predictive value of 3D-TEE-xPlane in A1，A2，A3，P1，P2 and P3 area prolapse recognition is also improved（61.1% vs 94.1%，66.7% vs 95.0%，58.8% vs 93.3%，64.7% vs 100.0%，81.1% vs 100.0%，72.4% vs 96.3%），the negative predictive value of 3D-TEE-xPlane in A1and A2 area prolapse recognition is also improved（93.0% vs 100%，84.0% vs 97.9%）（all P＜0.05）.Compared with intraoperation，2D-TTE has moderate consistency in identifying mitral valve prolapse in A1，A3，and P1 areas （A1=0.541, A3=0.546, P1=0.567）；and has strong consistency in identifying other leaflet prolapses（A2=0.617, P2=0.717, P3=0.641）.However，the diagnosis were strong consistent with intraoperation by 3D-TEE-xPlane in the recognition of the prolapsed leaflets（A1=0.928, A2=0.967, A3=0.920,P1=0.963,P2=0.978, P3=0.948）（all P＜0.05）.Conclusion 3D-TEE-xPlane imaging is an accurate，easy-to-use and easy-to-interpret imaging method that can assess the location of mitral valve prolapse more accurately. |
| Key words: Echocardiography, two-dimensional, transthoracic Three-dimensional, transesophageal xPlane, mitral valve prolapse |
