经食管超声心动图联合右心声学造影诊断隐匿性脑卒中的应用

Application of Transesophageal Echocardiography Combined with Contrast Transthoracic Echocardiography in Diagnosis of Cryptogenic Ischemic Stroke

选取147例隐匿性脑卒中(CIS)患者进行回顾性研究,其中卵圆孔未闭(PFO)相关CIS患者99例(PFO组)、非PFO相关CIS患者48例(非PFO组),均行经食管超声心动图(TEE)和右心声学造影(cTTE)检查,比较二者的PFO检出率、右向左分流(RLS)分级情况及安全性;对比两组患者的反常性栓塞风险量表(RoPE)、PFO内径、PFO长度,采用接收者操作特征(ROC)曲线及ROC下面积(AUC)评价诊断效能;并分析了RoPE评分与PFO内径、RLS分级的相关性。结果发现,cTTE+TEE检出PFO阳性率(67.35%)高于cTTE(55.10%),检出RLS分级Ⅰ+Ⅱ+Ⅲ级患者占比(64.63%)高于cTTE(53.06%),RoPE评分+PFO内径联合诊断PFO相关CIS的AUC最高(0.928),RoPE评分与PFO内径、RLS分级均呈正相关(P<0.05)。综上,cTTE联合TEE可提高PFO检出率并判断RLS程度,RoPE评分和PFO内径可用于PFO-RLS相关性CIS的诊断。

A total of 147patients with cryptogenic ischemic stroke(CIS)were selected for a retrospective study.Among them,there were 99patients with patent foramen ovale(PFO)related CIS(PFO group)and 48patients with non-PFO related CIS(non-PFO group).All patients underwent transesophageal echocardiography(TEE)and contrast transthoracic echocardiography(cTTE).The detection rate of cTTE and cTTE+TEE for PFO and right-to-left shunt(RLS)grade were compared,as well as their safety.And the score of paradoxical embolism(RoPE)scale,the inner diameter of PFO,the length of PFO were compared between the two groups.The receiver operating characteristic(ROC)curve and the area under the ROC(AUC)were used to analyze the diagnostic efficacy.The correlation between RoPE score,PFO inner diameter and RLS classification were also analyzed.The results showed that the positive rate of PFO detected by cTTE+TEE(67.35%)was higher than that of cTTE(55.10%).The proportion of patients with RLS gradeⅠ+Ⅱ+Ⅲ(64.63%)detected by cTTE+TEE was also higher than that of cTTE(53.06%).The highest AUC of RoPE score combined with the inner diameter of PFO in diagnosis of PFO-related CIS was 0.928,and RoPE score was positively correlated with inner diameter of PFO and RLS classification(P<0.05).In summary,cTTE combined with TEE can improve the detection rate of PFO and judge the degree of RLS collectly.RoPE score and inner diameter of PFO can be used for the diagnosis of PFO-RLS-related CIS.