经食管与经胸超声心动图造影诊断卵圆孔未闭及右向左分流

Contrast transesophageal echocardiography and contrast transthoracic echocardiography for diagnosis of patent foramen ovale and right to left shunt

目的对比经食管超声心动图造影(cTEE)与经胸超声心动图造影(cTTE)诊断卵圆孔未闭(PFO)及右向左分流(RLS)的价值。方法回顾性分析117例因偏头痛或隐源性卒中就诊的患者,均依次接受TTE、cTTE、TEE及cTEE检查;比较cTTE与cTEE诊断PFO的敏感度、特异度及对RLS分级的差异,观察二者诊断价值。结果TEE联合cTEE共检出89例(76.07%,89/117)PFO;TTE、cTTE、TEE及cTEE分别检出18例(20.22%,18/89)、80例(89.89%,80/89)、75例(84.27%,75/89)及88例(98.88%,88/89)。cTTE存在9例(10.11%,9/89)假阴性、7例(25.00%,7/28)假阳性;cTEE存在1例(1.12%,1/89)假阴性,无假阳性病例。cTEE诊断PFO的敏感度(98.88%)及特异度(100%)均高于cTTE(89.89%、75.00%;χ^(2)=6.125、5.143,P=0.008、0.016);cTEE的PFO-RLS分级结果总体低于cTTE(Z=-3.464,P=0.001)。结论cTEE诊断PFO的敏感度及特异度均高于cTTE,而其PFO-RLS分级总体低于cTTE。

Objective To compare the value of contrast transesophageal echocardiography(cTEE)and contrast transthoracic echocardiography(cTTE)for diagnosing patent foramen ovale(PFO)and right to left shunt(RLS).Methods Totally 117 patients with migraine or cryptogenic stroke who underwent TTE,cTTE,TEE and cTEE in sequence were retrospectively analyzed.The sensitivity and specificity for diagnosis of PFO and RLS classification were compared between cTTE and cTEE,and the diagnostic values were observed.Result TEE combined with cTEE detected PFO in 89 cases(76.07%,89/117).Among them,TTE,cTTE,TEE and cTEE detected 18 cases(20.22%,18/89),80(89.89%,80/89),75(84.27%,75/89)and 88 cases(98.88%,88/89),respectively.False negative PFO was found in 9 cases(10.11%,9/89)and false positive PFO was diagnosed in 7 cases(25.00%,7/28)by cTEE,while cTEE diagnosed 1 false negative case(1.12%,1/89)but no false positive one.Both the sensitivity(98.88%)and specificity(100%)of cTEE for diagnosing PFO were higher than those of cTTE(89.89%,75.00%)(χ^(2)=6.125,5.143;P=0.008,0.016).PFO-RLS classification results of cTEE were lower than that of cTTE(Z=-3.464,P=0.001).Conclusion The sensitivity and specificity of cTEE for diagnosing PFO were higher than those of cTTE,while PFO-RLS classification of cTEE were lower than cTTE.