Медицинская литература. Новинки

 

 

 

 

 

 

Согласованность эхокардиографической оценки тяжести митральной регургитации методами волюметрии и PISA с данными МРТ у пациентов со вторичной митральной регургитацией со сниженной фракцией выброса

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Цель исследования: сравнить согласованность эхокардиографических показателей Vмр и фракции регургитации (ФР), полученных методом PISA и волюметрическим методом, с показателями Vмр и ФР, полученных c помощью МРТ, у пациентов со вторичной митральной регургитацией (МР) со сниженной ФВ ЛЖ.Материал и методы. В анализ были включены данные 433 пациентов со вторичной МР со сниженной ФВ ЛЖ (менее 35%). Пациенты были разделены на 2 группы: 1-я группа: 286 пациентов, средний возраст 64 ± 10 лет, у которых вычисление Vмр и ФР проводилось методом PISA. 2-я группа: 147 пациентов, средний возраст 63 ± 11 лет, у которых вычисление Vмр и ФР проводилось волюметрическим методом.Результаты. Выявлена умеренная корреляционная связь между показателями, полученными по данным МРТ и эхокардиографии в зависимости от применяемого метода: волюметрический метод – Vмр r = 0,54, р = 0,01 и ФР r = 0,56, р = 0,01, метод PISA – Vмр r = 0,36, р = 0,01 и ФР r = 0,3, р = 0,01. Согласованность в категориальных оценках тяжести МР между методом PISA и МРТ составила 27% в диагностике тяжелой МР и 50% в диагностике умеренной МР. Согласие в категориальных оценках тяжести МР между волюметрическим методом и МРТ составило 46% в диагностике тяжелой МР и 65% в диагностике умеренной МР. При анализе методом Бланда–Альтмана средняя разница Vмр между методом PISA и МРТ cоставила 7,6 ± 13 мл с пределами совпадения (30; –25 мл), а средняя разница Vмр между волюметрическим методом и МРТ cоставила –2,5 ± 7,3 мл с пределами совпадения (–12; 17 мл).Заключение. Показатели МРТ и эхокардиографии вне зависимости от применяемого метода имеют умеренную согласованность в оценке Vмр и ФР у пациентов со вторичной МР при сниженной ФВ. Волюметрический метод может являться методом выбора при расчетах количественных показателей тяжести МР, так как обладает лучшей согласованностью с данными МРТ в сравнении с методом PISA.

Ключевые слова:
митральная регургитация, волюметрический метод, фракция регургитации, МРТ, mitral regurgitation, volumetric method, regurgitation fraction, MRI

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Consistency of echocardiographic assessment of the severity of mitral regurgitation using volumetric and PISA methods with MRI data in patients with secondary mitral regurgitation with reduced ejection fraction

Objectives: to compare the consistency of echocardiographic Vmr and FR obtained by PISA and volumetric methods with Vmr and FR obtained by MRI in patients with secondary MR with reduced LV EF.Materials and methods. The analysis included data from 433 patients with secondary mitral regurgitation with reduced LV EF (less than 35%). The patients were divided into 2 groups: Group 1 – 286 patients with an average age of 64 ± 10 years, in whom the calculation of Rvol and RF was carried out by the PISA method. Group 2 – 147 patients with an average age of 63 ± 11 years, in whom the calculation of Rvol and RF was carried out by the volumetric method.Results. A moderate correlation was found between the indicators obtained by MRI and echocardiography, regardless of the method used, volumetric method Rvol r = 0.54 p = 0.01 and RF r = 0.56, p = 0.01, PISA method Rvol, r = 0.36, p = 0.01 and RF, r = 0.3, p = 0.01. The agreement in MR severity categorical scores between PISA and MRI was 27% in the diagnosis of severe mitral regurgitation and 50% in the diagnosis of moderate MR. The consistency in categorical MR severity scores between volumetric and MRI was 46% in the diagnosis of severe mitral regurgitation and 65% in the diagnosis of moderate MR. In the Bland–Altman analysis, the average difference in Rvol between PISA and MRI was 7.6 ± 13 ml with coincidence limits (30; –25 ml), the average difference in Rvol between volumetric and MRI was –2.5 ± 7.3 ml with coincidence limits (–12; 17 ml).Conclusions. MRI and echocardiography regardless of the method used have only a moderate correlation in the assessment of Rvol and RF in patients with secondary MR with reduced EF. The volumetric method may be the method of choice when calculating quantitative indicators of MR severity, as it has better agreement with MRI data compared to the PISA method.

Keywords:
митральная регургитация, волюметрический метод, фракция регургитации, МРТ, mitral regurgitation, volumetric method, regurgitation fraction, MRI