Journal of the American Society of Echocardiography ( IF 5.4 ) Pub Date : 2021-06-29 , DOI: 10.1016/j.echo.2021.06.011 Tongran Qin 1 , Andrés Caballero 2 , Rebecca T Hahn 3 , Raymond McKay 4 , Wei Sun 1
|
Background
Mitral regurgitation (MR) quantification by the proximal isovelocity surface area (PISA) method remains challenging. Using computer models, the authors evaluated the accuracy of different PISA methods and quantified their errors.
Methods
Five functional MR computer models of different geometric and tethering abnormalities were created, validated, and treated as phantom models, from which the reference values were directly obtained. Virtual two-dimensional (2D) PISA and three-dimensional (3D) PISA (both peak and integrated values) were performed on these phantom models. By comparing virtual PISA results with reference values, the accuracy of different PISA methods was evaluated, and their sources of errors were quantified.
Results
Compared with reference values of regurgitant flow rate, excellent correlations were found for true PISA (r = 0.99, bias = 32.3 ± 35.3 mL/sec), 3D PISA (r = 0.97, bias = −24.4 ± 55.5 mL/sec), followed by multiplane 2D hemicylindrical PISA (r = 0.88, bias = −24.1 ± 85.4 mL/sec) and hemiellipsoidal PISA (r = 0.91, bias = −55.7 ± 96.6 mL/sec). Weaker correlations were found for single-plane 2D hemispherical PISA (parasternal long-axis: r = 0.71, bias = −77.6 ± 124.5 mL/sec; apical two-chamber: r = 0.69, bias = −52.0 ± 122.0 mL/sec; apical four-chamber: r = 0.82, bias = −65.5 ± 107.3 mL/sec). For regurgitant volume quantification, integrated PISA was more accurate than peak PISA. The bias of 3D PISA improved from −12.7 ± 7.8 mL (peak PISA) to −2.1 ± 5.3 mL (integrated PISA).
Conclusions
For functional MR quantification, 2D hemispherical PISA had significant underestimation, multiplane 2D hemiellipsoidal and hemicylindrical PISA showed improved accuracy, and 3D PISA was the most accurate. The PISA method is subject to both systematic underestimation due to the Doppler angle effect and systematic overestimation when regurgitant flow is not perpendicular to PISA contour. Integrated PISA is able to capture dynamic MR and is therefore more accurate than peak PISA. The sum of regurgitant flow rates is the most feasible way to perform integrated PISA.
中文翻译：
功能性二尖瓣关闭不全的虚拟超声心动图评估的计算分析，用于验证近端等速表面积方法
背景
通过近端等速表面积 (PISA) 方法对二尖瓣反流 (MR) 进行量化仍然具有挑战性。作者使用计算机模型评估了不同 PISA 方法的准确性并量化了它们的错误。
方法
五个不同几何和系留异常的功能 MR 计算机模型被创建、验证并作为幻影模型处理，从中直接获得参考值。在这些体模模型上进行了虚拟二维 (2D) PISA 和三维 (3D) PISA（峰值和积分值）。通过将虚拟 PISA 结果与参考值进行比较，评估了不同 PISA 方法的准确性，并量化了它们的误差来源。
结果
与反流流速的参考值相比，真实 PISA（r = 0.99，偏差 = 32.3 ± 35.3 mL/sec）、3D PISA（r = 0.97，偏差 = -24.4 ± 55.5 mL/sec）具有极好的相关性，随后由多平面 2D 半圆柱形 PISA（r = 0.88，偏差 = -24.1 ± 85.4 mL/sec）和半椭球形 PISA（r = 0.91，偏差 = -55.7 ± 96.6 mL/sec）。单平面二维半球形 PISA 的相关性较弱（胸骨旁长轴：r = 0.71，偏差 = -77.6 ± 124.5 mL/sec；心尖二腔：r = 0.69，偏差 = -52.0 ± 122.0 mL/sec；心尖四腔：r = 0.82，偏差 = -65.5 ± 107.3 毫升/秒）。对于反流体积定量，积分 PISA 比峰值 PISA 更准确。3D PISA 的偏差从 -12.7 ± 7.8 mL（峰值 PISA）提高到 -2.1 ± 5.3 mL（综合 PISA）。
结论
对于功能 MR 量化，2D 半球 PISA 显着低估，多平面 2D 半椭球和半圆柱 PISA 显示出提高的准确性，3D PISA 是最准确的。由于多普勒角效应，PISA 方法会受到系统性低估和反流不垂直于 PISA 轮廓时的系统性高估。集成 PISA 能够捕获动态 MR，因此比峰值 PISA 更准确。反流流速的总和是执行综合 PISA 的最可行方法。
京公网安备 11010802027423号