四等级三尖瓣反流分级较指南三等级分级的临床适用性研究  

Clinical applicability of the four-grade tricuspid regurgitation classification in relation to the guideline-recommended three-grade classification

作　　者：张曦 张宇新 谭碧君 侯颖 文立伟 袁丽君 邢长洋 Zhang Xi;Zhang Yuxin;Tan Bijun;Hou Ying;Wen Liwei;Yuan Lijun;Xing Changyang(Department of Ultrasound Diagnostics,Tangdu Hospital,Air Force Medical University,Xi′an 710038,China)

机构地区：[1]空军军医大学唐都医院超声医学科,西安710038

出　　处：《中华超声影像学杂志》2024年第6期475-481,共7页Chinese Journal of Ultrasonography

基　　金：陕西省重点研发计划(2024SF-YBXM-019);空军军医大学第二附属医院“尖子人才”资助基金。

摘　　要：目的探讨近年来学界提倡的四等级分级(G4)相较于指南三等级分级(G3)在功能性三尖瓣反流(FTR)中的临床适用性。方法前瞻性连续纳入2023年5-12月在空军军医大学唐都医院门诊及住院就诊的FTR患者137例。所有患者均接受超声心动图检查,并参照2017年美国超声心动图学会瓣膜评估指南为参考标准进行反流等级划分。将纳入的反流患者按指南G3和学界近年提倡的G4分别进行分组,通过Kappa检验对二者在FTR反流程度分级中的多指标与单指标进行一致性分析,并采用ROC曲线分析缩流颈宽度(VCW)、彩色反流束面积(A_(Jet))、PISA半径(R_(PISA))相关定量反流参数对G4的诊断效能。结果一致性分析结果显示,相较于G3,G4多指标综合评估与单指标评估中反流容积(RVol)一致性显著提高(Kappa值0.84比0.30);有效反流口面积(EROA)与VCW一致性等级不变(Kappa值分别为0.76比0.89,0.51比0.66)。ROC曲线分析显示,对于G4,A_(Jet)、R_(PISA)、VCW对轻度与中度反流区分能力的曲线下面积(AUC)分别为0.854、0.993、0.894,对中度与中重度反流区分能力的AUC分别为0.899、0.979、0.917。结论对于FTR,目前学界提倡的G4相较于G3在单指标与综合指标分级一致性方面表现更佳,临床适用性好;A_(Jet)、R_(PISA)、VCW可补充至G4,有助于完善其定量评估体系。Objective To investigate the clinical applicability of the four-grade grading(G4)advocated by the academy in recent years compared with the guideline-recommended three-grade grading(G3)in functional tricuspid regurgitation(FTR).Methods A total of 137 consecutive patients were prospectively included from outpatient and inpatient clinics at Tangdu Hospital,Air Force Medical University from May to December 2023.All patients underwent echocardiography and were graded for regurgitation based on the 2017 American Society of Echocardiography Valve Evaluation Guidelines as the reference standard.The patients with regurgitation were grouped according to the G3 based on the guidelines and the G4 advocated by the academic community in recent years,respectively.The consistency of the regurgitation grading between multi-indicators and single-indicators was analyzed using the Kappa test for both G3 and G4.The quantitative regurgitation relevant parameters were analyzed using ROC curves to evaluate the diagnostic efficacies for G4,including the vena contracta width(VCW),the area of the color flow jet(A_(Jet)),and the radius of the PISA(R_(PISA)).Results The results of consistency analysis showed that the consistency of regurgitation volume(RVol)was significantly higher in the G4 multi-indicators comprehensive assessment versus the single-indicators assessment compared with the G3,with a Kappa value of 0.84 vs.0.30.The consistency of effective regurgitant orifice area(EROA)and VCW remained unchanged,with a Kappa value of 0.76 vs.0.89,0.51 vs.0.66.ROC curve analysis showed that for the G4,the area under the curve(AUC)for moderate regurgitation were 0.854,0.993,and 0.894,respectively,while for moderate-severe regurgitation,these values were 0.899,0.979,and 0.917,respectively.Conclusions For FTR,the G4 currently advocated by the academic community has better consistency between single-indicators and comprehensive indicators grading than the G3 based on the guideline,which is clinically applicable;A_(Jet),R_(PISA),and VCW can be sup

关 键 词：超声心动描记术 二维 功能性三尖瓣反流 反流严重程度分级 

分 类 号：R542.53[医药卫生—心血管疾病] R540.45[医药卫生—内科学]