经胸及经食管超声心动图在急性A型主动脉夹层诊断中的应用

Application of transthoracic and transesophageal echocardiography in diagnosis of acute type A aortic dissection

目的分析经胸超声心动图(TTE)和经食管超声心动图(TEE)在急性A型主动脉夹层(ATAAD)诊断中的应用价值。方法分别对78例在河南省胸科医院确诊并行手术治疗的ATAAD患者进行TTE和TEE检查,比较两种检查方式的检查结果、表征、冠状动脉受累情况及主动脉根部受累分型进行比较。结果TEE和TTE检查在主动脉窦部内径、升主动脉内径、主动脉瓣返流及心包积液等方面比较,差异无统计学意义(P>0.05),但TEE检查结果的阳性检出率、破口显示率及≥1项表征检出率高于TTE检查(P<0.05);TEE检查夹层累及冠状动脉的检出准确率为83.3%,敏感性为83.3%,与TTE检查中冠状动脉受累检出准确率(66.7%)和敏感性(66.7%)比较,差异无统计学意义(P>0.05);但TEE检测的特异性(98.5%)高于TTE(92.4%)(P<0.05),TTE检查显示A1、A2和A3型阳性检出准确率分别为85.3%、80.0%和87.5%,TEE检查显示A1、A2和A3型阳性检出准确率分别为94.1%、85.0%和100%,两种检查方式准确率比较,差异无统计学意义(P>0.05)。结论TEE检查对ATAAD的阳性检出率、破口显示率及冠状动脉受累的特异性均高于TTE检查,提高了早期诊断率。

【Objective】To analyze the value of transthoracic echocardiography(TTE)and transesophageal echocardiography(TEE)in the diagnosis of acute A-type aortic dissection(ATAAD).【Methods】TTE and TEE were performed in 78 patients with confirmed ATAAD and surgical treatment,and the results,characterization,coronary artery involvement and types of aortic root involvement were compared between the two methods.【Results】There were no significant differences between TEE and TTE in aortic sinus diameter,ascending aorta diameter,aortic regurgitation and pericardial effusion(P>0.05),but the positive detection rate,rupture detection rate and≥1 characteristic detection rate of TEE were significantly higher than those of TTE(P<0.05).TEE detection rate of coronary artery involvement by dissection was 83.3%,sensitivity was 83.3%,which were not significantly different from the the accuracy(66.7%),sensitivity(66.7%)of TTE(P>0.05);while the specificity of TEE was 98.5%,significantly higher than the specificity(92.4%)of TTE(P<0.05).TTE showed that the positive detection accuracy of A1,A2 and A3 was 85.3%,80.0%and 87.5%,respectively,TEE showed that the positive detection accuracy of A1,A2 and A3 were 94.1%,85.0%and 100%,respectively,and the difference was not statistically significant(P<0.05).【Conclusion】The positive detection rate,rupture detection rate and specificity of coronary artery involvement of TEE were higher than those of TTE,which improved the early diagnosis rate.