cTEE、cTCD及TEE对卵圆孔未闭的临床诊断价值

Clinical value of c TEE, c TCD and TEE in the diagnosis of patent foramen ovale

目的:探讨经胸右心声学造影(cTTE)、经颅多普勒发泡试验(cTCD)及食道心超(TEE)等检查对卵圆孔未闭(PFO)的诊断价值。方法:回顾性分析比较140例温州医科大学附属第一医院成功行PFO封堵术患者(A组)与右心导管检查未见PFO患者(B组)的临床资料,包括临床基线资料、cTTE、cTCD及TEE。比较两组间在cTTE、cTCD分流量大小、TEE卵圆孔大小差异及cTTE气泡出现的时间差异,并绘制这些指标诊断PFO的ROC曲线。结果:cTTE下A组与B组比中-大量分流占比更大。在静息状态、瓦氏动作后和总评分情况下A组中-大量分流占比均显著大于B组(67.35%vs. 42.86%,P=0.04;100.00%vs. 71.42%,P<0.001;81.63%vs. 51.43%,P=0.004)。c TCD下A组与B组相比中-大量分流占比更大(75.90%vs. 19.35%,P <0.001)。TEE下A组与B组相比PFO裂隙更大(2.18±0.78 vs. 1.19±0.78,P<0.001)。用cTTE、cTCD、TEE等指标做PFO诊断的ROC曲线,结果提示cTCD、TEE两个指标ROC曲线下面积较大,具有较好的敏感度和特异度(P<0.05)。在cTTE气泡出现的时间方面,A组气泡出现时间小于等于5个心动周期的患者比例显著大于B组(73.47%vs.42.86%,P=0.007)。结论:c TCD、TEE检查对于PFO有较好的预测价值,综合价值优于cTTE检查。

Objective: To investigate the diagnostic value of transthoracic right phonography(cTTE),transcranial Doppler foaming test(cTCD) and esophageal echocardiography(TEE) in patent foramen ovale(PFO). Methods: Clinical data of 140 patients with PFO closure in our hospital(group A) and patients without PFO in right heart catheterization(group B) were retrospectively analyzed and compared, including clinical baseline data, cTTE, cTCD and TEE. The differences in cTTE, cTCD shunt volume, TEE foramen ovale size and cTTE bubble appearance time were compared between the two groups. The ROC curve of these indicators in the diagnosis of PFO was drawn. Results: The proportion of medium-large shunt in cTTE was higher in group A than group B. The proportion of medium-large shunt in group A was higher than group B in resting,post-Valsalva and total respectively(67.35% vs. 42.86%, P=0.04;100.00% vs. 71.42%, P<0.001;81.63% vs.51.43%, P=0.004). The proportion of medium-large shunt in cTCD was higher in group A than group B(75.90%vs. 19.35%, P<0.001). The PFO diameter of group A was larger than group B in TEE(2.18±0.78 vs. 1.19±0.78,P<0.001). The ROC curves of cTTE, cTCD and TEE showed that the AUC of cTCD and TEE had larger and better sensitivity and specificity. The proportion of bubble appearance within 5 cardiac cycles in cTTE in group A was significantly higher than B(73.47% vs. 42.86%, P=0.007). Conclusion: c TCD and TEE have good predictive value for PFO, with better comprehensive value than cTTE.