[1]田晓光 陈武 徐琨 刘晓芳.经胸超声心动图声学造影与对比增强经颅多普勒对卵圆孔未闭右向左分流的筛查价值[J].心血管病学进展,2022,(4):371-374.[doi:10.16806/j.cnki.issn.1004-3934.2022.04.020]
　TIAN Xiaoguang,CHEN WuXU Kun,LIU Xiaofang.The Screening Value of Contrast Transthoracic Echocardiography and Contrast-Enhanced Transcranial Doppler in the Right to Left Shunt of Patent Foramen Ovale[J].Advances in Cardiovascular Diseases,2022,(4):371-374.[doi:10.16806/j.cnki.issn.1004-3934.2022.04.020]
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经胸超声心动图声学造影与对比增强经颅多普勒对卵圆孔未闭右向左分流的筛查价值(/HTML)
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2022年4期
页码:
371-374
栏目:
论著
出版日期:
2022-04-25

文章信息/Info

Title:
The Screening Value of Contrast Transthoracic Echocardiography and Contrast-Enhanced Transcranial Doppler in the Right to Left Shunt of Patent Foramen Ovale
作者:
田晓光1 陈武2 徐琨2 刘晓芳2
(1.山西医科大学医学影像学院,山西 太原 030001;2.山西医科大学第一医院超声科,山西 太原 030001)
Author(s):
TIAN Xiaoguang1; CHEN Wu2XU Kun2; LIU Xiaofang2
(1.School of Medical Imaging ,,Shanxi Medical University,Taiyuan 030001,Shanxi,China2.Department of UltrasoundThe First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China)
关键词:
卵圆孔未闭; 经胸超声心动图声学造影; 对比增强经颅多普勒; 经食管超声心动图声学造影
Keywords:
Patent foramen ovale;  Contrast transthoracic echocardiography; Contrast-enhanced transcranial oppler; Contrast transesophageal echocardiography
DOI:
10.16806/j.cnki.issn.1004-3934.2022.04.020
摘要:
目的 探讨经胸超声心动图声学造影（cTTE）与对比增强经颅多普勒（cTCD）对卵圆孔未闭右向左分流的筛查价值。方法 选取2019年10月2021年6月因偏头痛、不明原因脑卒中、头晕短暂性脑缺血发作就诊于山西医科大学第一医院神经内科，临床高度怀疑卵圆孔未闭PFO）的92例患者，行经食管超声心动图声学造影（cTEE）、cTTEcTCD检查。右心房造影剂充分显影后，cTTE检查在3或5个心动周期内左心观察到微泡分别命名为cTTE3cTTE5；cTCD半定量分级级命名为cTCDⅡ，cTCD半定量分级为Ⅲ级命名为cTCD；cTTE3+cTCD、cTTE5+cTCD分别为上述两种方法均阳性的联合检查。以cTEE为金标准，比较上述各种方法检测PFO的敏感性、特异、阴性似然比（）及误诊率。结果 92例患者，cTEE检查有81例PFO阳性，11例PFO阴性。在充分的Valsalva动作下，cTTE3作为检测PFO阳性的截断值，敏感性、特异、误诊率分别为52%、90%、59%和10%；同理，cTTE5的敏感性、特异、和误诊率分别为64%、80%、44%和20%。cTCD作为检测PFO阳性的截断值，敏感性、特异、和误诊率分别为76%、73%、36%和27%，同理；cTCD敏感性、特异和、误诊率分别为49%、90%、55%和9%。cTTE与cTCD联合诊断PFO，特异提高，误诊率降低，尤其是cTTE3+cTCD联合，特异达100%，误诊率为0。结论 cTTE与cTCD单独应用对PFO的筛查具有较高的临床参考价值。二者联合应用均可以提高PFO诊断的特异，尤其是以cTTE3+cTCD作为截断值。
Abstract:
Objective To investigate the screening value of contrast transthoracic echocardiography (cTTE) and contrast-enhanced transcranial Doppler (cTCD) in the right to left shunt of patent foramen ovale. Methods A total of 92 patients with highly suspected patent foramen ovale(PFO) who were admitted to the Department of Neurology of the First Hospital of Shanxi Medical University from October 2019 to June 2021 due to migraine,unexplained stroke,dizziness,and transient ischemic attack were selected and examined for cTTE,cTTE and cTCD. After full development of right atrium contrast media by cTTE examination,microbubbles were observed in the left heart within 3 or 5 cardiac cycles,were named cTTE3 or cTTE5 respectively. cTCD semi-quantitative classification≥Ⅱ was named cTCDⅡ,and cTCD semi-quantitative classification Ⅲ was named cTCDⅢ; cTTE3+cTCDⅢ and cTTE5+cTCDⅡ were combined positive tests of the above two methods respectively. Using cTEE as the gold standard,the sensitivity,specificity,negative likelihood ratio (－LR) and misdiagnosis rate of PFO were compared. Results Among 92 patients,81 were PFO positive and 11 were PFO negative. Under sufficient Valsalva action,cTTE3 was used as the cutoff value for detecting positive PFO,and the sensitivity,specificity,－LR and misdiagnosis rate were 52%,90%,59% and 10%,respectively. Similarly,the sensitivity,specificity,－LR and misdiagnosis rate of cTTE5 were 64%,80%,44% and 20%,respectively. The sensitivity,specificity,－LR and misdiagnosis rate of cTCDⅡ as the cutoff value of positive PFO were 76%,73%,36% and 27%,respectively. The sensitivity,specificity,－LR and misdiagnosis rate of cTCDⅢ were 49%,90%,55% and 9%,respectively. Combined diagnosis of PFO by cTTE and cTCD showed higher specificity and lower misdiagnosis rate,especially the combination of cTTE3+cTCDⅢ showed 100% specificity and 0 misdiagnosis rate. Conclusion The application of cTTE and cTCD alone has high clinical reference value for the screening of PFO. Combined application of the two methods can improve the specificity of PFO diagnosis,especially when cTTE3+cTCDⅢ is used as the cutoff value.

参考文献/References:

[1].张玉顺,蒋世良,朱鲜阳.卵圆孔未闭相关卒中预防中国专家指南[J].心脏杂志,2021,33(1):1-10.
[2].Buchholz SShakil A,Figtree GA,et al. Diagnosis and management of patent foramen ovale[J]. Postgrad Med J,2012,88(1038):217-225.
[3].Saver JL,Carroll JD,Thaler DE,et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke[J]. N Engl J Med,2017,377(11):1022-1032.
[4].Komar M,Podolec P,Przew?ocki T,et al. Transoesophageal echocardiography can help distinguish between patients with "symptomatic" and "asymptomatic" patent foramen ovale[J]. Kardiol Pol,2012,70(12):1258-1263.
[5].Kumar P,Rusheen J,Tobis JM. A comparison of methods to determine patent foramen ovale size[J]. Catheter Cardiovasc Interv,2020,96(6):E621-E629.
[6].Chen J,Chen L,Hu W,et al. A comparison of contrast transthoracic echocardiography and contrast transcranial Doppler in cryptogenic stroke patients with patent foramen ovale[J]. Brain Behav,2019,9(5):e01283.
[7].Yang Y,Guo ZN,Wu J,et al. Prevalence and extent of right-to-left shunt in migraine:a survey of 217 Chinese patients[J]. Eur J Neurol,2012,19(10):1367-1372.
[8].He D,Shi Q,Xu G,et al. Clinical and infarction patterns of PFO-related cryptogenic strokes and a prediction model[J]. Ann Clin Transl Neurol,2018,5(11):1323-1337.
[9].谢坚,王玉凯,彭伟英,等. 经食管超声心动图右心声学造影与对比增强TCD检查在检测隐源性脑卒中患者右向左分流的效果比较[J]. 临床神经病学杂志2018,31(5):341-343.
[10].Woods TD,Patel A. A critical review of patent foramen ovale detection using saline contrast echocardiography:when bubbles lie[J]. J Am Soc Echocardiogr,2006,19(2):215-222.
[11].Mitchell C,Rahko PS,Blauwet LA,et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults:recommendations from the American Society of Echocardiography[J]. J Am Soc Echocardiogr,2019,32(1):1-64.
[12].李越,刘若卓,翟亚楠,等. 健康志愿者右心声学造影结果的初步分析[J]. 中华医学超声杂志(电子版),2014,11(2):135-141.
[13].Yang JZhang H,Wang Y,et al. The efficacy of contrast transthoracic echocardiography and contrast transcranial Doppler for the detection of patent foramen ovale related to cryptogenic stroke[J]. Biomed Res Int,2020,2020:1513409.

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更新日期/Last Update: 2022-05-13