摘要
目的探讨经胸超声心动图造影(c-TTE)筛查卵圆孔未闭合并右向左分流(PFO-RLS)的应用价值。方法收集我院神经内科因偏头疼或隐源性脑卒中就诊初步怀疑PFO患者103例,依次接受c-TTE和经食管超声心动图造影(c-TEE)检查,观察静息和Valsalva动作下,c-TTE和c-TEE检出PFO-RLS的阳性率;以c-TEE检查结果为金标准,观察静息和Valsalva动作下c-TTE对PFO-RLS诊断效能评价。结果静息状态下c-TTE的阳性率为38.83%,c-TEE阳性率为40.78%,Valsalva动作下两种检查方法的阳性率均显著性提高(均P<0.05),分别为80.58%与82.52%,静息和Valsalva动作下,c-TTE与c-TEE两组间阳性率比较差异均无统计学意义;相对于金标准c-TEE,静息状态c-TTE对PFO-RLS的阳性预测值为100%,阴性预测值为96.82%,灵敏度为95.23%,特异度为100%,准确率为98.05%,一致性Kappa值为0.95。Valsalva动作下,c-TTE对PFO-RLS的阳性预测值为98.79%,阴性预测值为85.00%,灵敏度为96.47%,特异度为94.44%,准确率为96.11%,一致性Kappa值为0.87。结论对于诊断PFO-RLS患者,c-TTE具有较高的灵敏度、特异度及准确度,且微创、痛苦小,简单方便、易在临床推广应用,可将其作为PFO-RLS患者早期筛查手段,对准备行PFO封堵治疗的患者,进一步行c-TEE检查观察PFO解剖形态。
AIM To explore the application value of contrast transthoracic echocardiography(c-TTE)in screening patent foramen ovale with right to left shunt(PFO-RLS).METHODS A total of 103 patients with suspected PFO due to migraine or unexplained cerebral infarction in the Neurology Department of our hospital underwent c-TTE and contrast transesophageal echocardiography(c-TEE)examinations to observe the positive rate of PFO-RLS detected by c-TTE and c-TEE at rest and under Valsalva maneuver.The results of c-TEE were regarded as the“gold standard”for PFO-RLS diagnosis and the diagnostic efficiency of c-TTE was evaluated under Valsalva maneuver.RESULTS The positive rates of c-tte and c-tee were 38.83%and 40.78%respectively at rest.The positive rates of the two methods were significantly higher under Valsalva action(all P<0.05),80.58%and 82.52%respectively.There was no significant difference between the positive rates of c-tte and c-tee between the two groups at rest and Valsalva action;Compared with the gold standard c-tee,the positive predictive value of resting c-tte for pfo-rls was 100%,the negative predictive value was 96.82%,the sensitivity was 95.23%,the specificity was 100%,the accuracy was 98.05%,and the consistency kappa value was 0.95.Under Valsalva action,the positive predictive value of c-tte for pfo-rls was 98.79%,the negative predictive value was 85.00%,the sensitivity was 96.47%,the specificity was 94.44%,the accuracy was 96.11%,and the consistency kappa value was 0.87.CONCLUSION c-TTE has high sensitivity,specificity and accuracy in the diagnosis of PFO-RLS patients.As c-TTE is minimally invasive,painless,convenient and easy to be popularized in clinical application,it can be used as an early screening method for PFO-RLS patients.c-TEE should be performed for accurate assessment of PFO morphologies when the closure is planned.
作者
许丹
孙蕾
李诗骜
周琦
XU Dan;SUN Lei;LI Shi-ao;ZHOU Qi(Department of Ultrasound,Second Affiliated Hospital,Xi’an Jiaotong University,Xi’an 710004,Shaanxi,China)
出处
《心脏杂志》
CAS
2023年第2期146-149,共4页
Chinese Heart Journal
基金
中央高校基本科研业务费专项资金(xzy012021059)。
关键词
卵圆孔未闭
右向左分流
经胸超声心动图造影
经食管超声心动图造影
patent foramen ovale
right to left shunt
contrast transthoracic echocardiography
contrast transesophageal echocardiography