TTE联合右心声学造影在卵圆孔未闭诊断及右向左分流评估中的应用价值

Application Value of TTE Combined with Right Echocardiography in the Diagnosis of Patent Foramen Ovale and the Assessment of Right-to-Left Shunt

目的探究经胸超声心动图(TTE)联合右心声学造影用于诊断卵圆孔未闭(PFO)及评估右向左分流(RLS)的价值。方法收集2022年8月—2023年3月收治100例疑似PFO的临床资料,开展回顾性研究。所有患者行TTE、右心声学造影及经食管超声心动图(TEE)检查,以TEE检查结果为“金标准”,比较TTE、右心声学造影单独与联合诊断PFO的价值及RLS的检出情况,并分析TTE联合右心声学造影评估RLS分级与TEE检查结果的一致性。结果TTE联合右心声学造影诊断PFO的敏感度(93.02%)和准确度(92.00%)均高于TTE(75.58%和78.00%)、右心声学造影(79.07%和80.00%)单独诊断(P<0.05)。TTE联合右心声学造影对RLS检出率(95.12%)高于右心声学造影(81.71%)单独检出率(P<0.01)。TTE联合右心声学造影评估RLS分级与TEE的一致性Kappa值为0.841(95%CI:0.724,0.959;P<0.001),符合率为88.37%。结论TTE联合右心声学造影诊断PFO的效果良好,且能清晰显示PFO患者RLS情况,可作为PFO临床诊断、治疗及随访的重要方法。

Objective To explore the value of transthoracic echocardiography(TTE)combined with right echocardiography in diagnosing patent foramen ovale(PFO)and evaluating right-to-left shunt(RLS).Methods Clinical data of 100 patients with suspected PFO treated from August 2022 to March 2023 were collected and retrospectively studied.All patients underwent TTE,right echocardiography and transesophageal echocardiography(TEE)examination.TEE examination results were used as the"gold standard"to compare the value of TTE and right echocardiography alone and in combination in diagnosing PFO and the detection of RLS,and to analyze the consistency of TTE combined with right echocardiography in evaluating RLS grading and TEE examination results.Results The sensitivity(93.02%)and accuracy(92.00%)of TTE combined with right echocardiography in the diagnosis of PFO were higher than those of TTE alone(75.58%and 78.00%)and right echocardiography alone(79.07%and 80.00%)(P<0.05).The detection rate of TTE combined with right echocardiography for RLS(95.12%)was higher than that of right echocardiography alone(81.71%)(P<0.01).The Kappa value of consistency between TEE and RLS grading assessed by TTE combined with right echocardiography was 0.841(95%CI was 0.724,0.959;P<0.001),and the coincidence rate was 88.37%.Conclusion TTE combined with right echocardiography has a good effect in the diagnosis of PFO,which can clearly show the RLS condition of PFO patients.Therefore,it can be used as an important method for clinical diagnosis,treatment and follow-up of PFO.