経食道心エコー検査による右室拍出量および三尖弁逆流量測定値の侵襲的検証
Luigi P Badano1, Claudia Baratto2, Michele Liberatore3
1Department of Cardiology, Ospedale San Luca IRCCS Istituto Auxologico Italiano, Milano, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
Background:
Quantifying tricuspid regurgitation (TR) severity by conventional Doppler echocardiography is challenging.
Objectives:
We sought to: validate right ventricular (RV) stroke volumes (SV3DE) and tricuspid regurgitant volumes (RegVol3DE) measured by three-dimensional echocardiography (3DE). Then, we compared the quantitative metrics used to assess TR severity obtained by 3DE and both the conventional and the corrected PISA methods.
Methods:
3DE RV and left ventricular (LV) SV were collected simultaneously with direct Fick measurements at right heart catheterization (RVSVRHC) in 45 patients (66±14 years, 76% women) with no or trivial TR, and in 57 consecutive patients (73±13 years, 61% women) with mild to torrential (14% mild, 37% moderate, 26% severe, 16% massive, and 7% torrential) TR, and mild or no mitral or aortic regurgitation. In the latter group, RHC and 3DE were combined to derive TR regurgitant volume (RegVol3DE-RHC=RVSV3DE-RVSVRHC) and compared to the 3DE volumetric RegVol (RegVol3DE =RVSV3DE-LVSV3DE). Effective regurgitant orifice area (EROA) and regurgitant fraction (RegFr) were calculated from RegVol3DE, as well as through conventional and corrected PISA methods.
Results:
The feasibility of RVSV3DE was 74%. Among patients with no or trivial TR, RVSV3DE and RVSVRHC showed a strong correlation (R2= 0.916, p<0.0001), with a minimal bias (3.7 mL) and reasonable precision (limits of agreement, LOA: -10 mL;18 mL). In those with mild to torrential TR, RegVol3DE correlated with RegVol3DE-RHC (R2=0.918, p<0.0001) and was accurate (bias= -1.3 mL, LOA:-17.9 mL;15.2 mL). EROA, RegVol and RegFr derived from conventional PISA (0.48±0.4 cm2, 38±20 mL, and 36±18%, respectively) were significantly smaller (p<0.05) than those obtained from corrected PISA (0.61±0.5 cm2, 48±24 mL, and 46±24 %, respectively), and volumetric 3DE (0.62±0.5 cm2, 46±25 mL, and 42±18%, respectively).
Conclusions:
RVSV measured by 3DE is accurate (minimal bias, acceptable imprecision) when compared to direct Fick RVSVRHC.
