The assessment of ventricular secondary mitral regurgitation (v-SMR) severity through effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) calculations using the proximal isovelocity surface area (PISA) method and the two-dimensional echocardiography volumetric method (2DEVM) is prone to underestimation. Accordingly, we sought to investigate the accuracy of the three-dimensional echocardiography volumetric method (3DEVM) and its association with outcomes in v-SMR patients. We included 229 patients (70 ± 13 years, 74% men) with v-SMR. We compared EROA and RegVol calculated by the 3DEVM, 2DEVM, and PISA methods. The end point was a composite of heart failure hospitalization and death for any cause. After a mean follow-up of 20 ±11 months, 98 patients (43%) reached the end point. Regurgitant volume and EROA calculated by 3DEVM were larger than those calculated by 2DEVM and PISA. Using receiver operating characteristic curve analysis, both EROA (area under the curve, 0.75; 95% CI, 0.68-0.81; = .008) and RegVol (AUC, 0.75; 95% CI, 0.68-0.82; = .02) measured by 3DEVM showed the highest association with the outcome at 2 years compared to PISA and 2DEVM ( < .05 for all). Kaplan-Meier analysis demonstrated a significantly higher rate of events in patients with EROA ≥ 0.3 cm (cumulative survival at 2 years: 28% ± 7% vs 32% ± 10% vs 30% ± 11%) and RegVol ≥ 45 mL (cumulative survival at 2 years: 21% ± 7% vs 24% ± 13% vs 22% ± 10%) by 3DEVM compared to those by PISA and 2DEVM, respectively. In Cox multivariable analysis, 3DEVM EROA remained independently associated with the end point (hazard ratio, 1.02, 95% CI, 1.00-1.05; = .02). The model including EROA by 3DEVM provided significant incremental value to predict the combined end point compared to those using 2DEVM (net reclassification index = 0.51, = .003; integrated discrimination index = 0.04, = .014) and PISA (net reclassification index = 0.80, < .001; integrated discrimination index = 0.06, < .001). Effective regurgitant orifice area and RegVol calculated by 3DEVM were independently associated with the end point, improving the risk stratification of patients with v-SMR compared to the 2DEVM and PISA methods.

中文翻译：

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三维超声心动图对心室继发性二尖瓣反流进行体积定量的临床影响

使用近端等速表面积 (PISA) 方法和二维超声心动图容积法 (2DEVM) 计算有效回流口面积 (EROA) 和回流体积 (RegVol)，评估心室继发性二尖瓣反流 (v-SMR) 严重程度容易被低估。因此，我们试图研究三维超声心动图容积法 (3DEVM) 的准确性及其与 v-SMR 患者预后的关系。我们纳入了 229 名 v-SMR 患者（70 ± 13 岁，74% 男性）。我们比较了通过 3DEVM、2DEVM 和 PISA 方法计算的 EROA 和 RegVol。终点是心力衰竭住院和全因死亡的复合终点。经过平均 20 ±11 个月的随访后，98 名患者 (43%) 达到了终点。 3DEVM计算的反流量和EROA大于2DEVM和PISA计算的结果。使用受试者工作特征曲线分析，通过以下方法测量 EROA（曲线下面积，0.75；95% CI，0.68-0.81；= .008）和 RegVol（AUC，0.75；95% CI，0.68-0.82；= .02）与 PISA 和 2DEVM 相比，3DEVM 与 2 年结果的相关性最高（均 < 0.05）。 Kaplan-Meier 分析表明，EROA ≥ 0.3 cm（2 年累积生存率：28% ± 7% vs 32% ± 10% vs 30% ± 11%）和 RegVol ≥ 45 mL（累积生存率）的患者的事件发生率显着较高。 2 年生存率：3DEVM 分别与 PISA 和 2DEVM 相比，分别为 21% ± 7% vs 24% ± 13% vs 22% ± 10%。在 Cox 多变量分析中，3DEVM EROA 仍然与终点独立相关（风险比，1.02，95% CI，1.00-1.05；= .02）。与使用 2DEVM（净重分类指数 = 0.51，= .003；综合辨别指数 = 0.04，= .014）和 PISA（净重分类指数 = 0.80）的模型相比，包含 3DEVM 的 EROA 的模型提供了显着的增量值来预测组合终点。 , < .001；综合歧视指数 = 0.06, < .001)。 3DEVM 计算的有效返流口面积和 RegVol 与终点独立相关，与 2DEVM 和 PISA 方法相比，改善了 v-SMR 患者的风险分层。