经胸超声心动图造影筛查卵圆孔未闭合并右向左分流的临床应用价值

Clinical application value of contrast transthoracic echocardiography in screening patent foramen ovale with right to left shunt

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.