TTE、c-TTE、c-TCD、TEE诊断卵圆孔未闭的对比研究

Comparative Study of TTE,c-TTE,c-TCD and TEE in Diagnosis of Patent Foramen Ovale

目的对比多种超声检查方法在卵圆孔未闭(PFO)诊断中的应用。资料与方法前瞻性分析2019年2月—2020年2月于内蒙古医科大学附属医院行PFO检查的185例患者,患者均第一步行经胸超声心动图(TTE)检查、第二步同步进行右心声学造影(c-TTE)与对比增强经颅多普勒超声(c-TCD)检查,第三步行经食管超声心动图(TEE)检查。c-TTE、c-TCD以诊断卵圆孔未闭-右向左分流(PFO-RLS)分为0、Ⅰ、Ⅱ、Ⅲ级,TTE、TEE以0、Ⅰ、Ⅱ、Ⅲ级分别对应的诊断PFO阳性率对比4种超声检查的效能。结果185例患者中阴性122例,阳性63例(静息状态24例,Valsalva动作39例),Valsalva动作后阳性率高于静息状态阳性率(χ^(2)=7.143,P=0.008)。Ⅰ级、Ⅱ级PFO-RLS:c-TTE与c-TCD阳性率差异无统计学意义(Ⅰ级χ^(2)=0.385,P=0.535;Ⅱ级χ^(2)=0.220,P=0.639),TTE与TEE对应分级检出PFO阳性率比较(Ⅰ级χ^(2)=0.534,P=0.465;Ⅱ级χ^(2)=1.366,P=0.243)差异无统计学意义;c-TTE、c-TCD阳性率高于TTE(P均=0.001)、TEE(P均=0.005)对应分级检出PFO阳性率,差异有统计学意义;Ⅲ级PFO-RLS:c-TTE、c-TCD阳性率与TEE对应Ⅲ级检出PFO阳性率一致,均高于TTE阳性率,差异有统计学意义(χ^(2)=27.230,P<0.001)。PFO检出阳性总数:c-TTE、c-TCD阳性率差异无统计学意义(χ^(2)=0.086,P=0.770),c-TTE阳性率高于TTE阳性率(χ^(2)=79.385,P<0.001)、TEE阳性率(χ^(2)=15.445,P<0.001),差异有统计学意义;c-TCD阳性率高于TTE阳性率(χ^(2)=76.222,P<0.001)、TEE阳性率(χ^(2)=13.572,P<0.001),差异有统计学意义;TEE阳性率高于TTE阳性率(χ^(2)=33.222,P<0.001)。c-TCD与c-TTE诊断一致50例,不一致13例。结论c-TTE、c-TCD可作为PFO-RLS检查的首选并应同步进行检查。

Purpose To compare the application of ultrasonography in the diagnosis of patent foramen ovale(PFO).Materials and Methods A total of 185 patients who underwent PFO examination in the Affiliated Hospital of Inner Mongolia Medical University from February 2019 to February 2020 were prospectively analyzed,all patients underwent transthoracic echocardiography(TTE)examination at the first step,and simultaneous right echocardiography(c-TTE)and contra-enhanced transcranial Doppler ultrasound(c-TCD)examination at the second step transesophageal echocardiography(TEE)examination at the third step.The c-TTE and c-TCD were divided into grades 0,Ⅰ,ⅡandⅢaccording to the diagnosis of patent foramina ovalis-right-to-left shraph(PFO-RLS),while TTE and TEE were compared with the positive rates of PFO corresponding to grades 0,Ⅰ,ⅡandⅢ,respectively.Results Among the 185 patients,122 were negative and 63 were positive(24 in resting state and 39 in Valsalva).The positive rate after Valsalva significantly was higher than that in resting state(χ^(2)=7.143,P=0.008).According toⅠandⅡgrade of PFO-RLS:there was no significant difference in positive rate between c-TTE and c-TCD(χ^(2)=0.385,P=0.535;χ^(2)=0.220,P=0.639),there was no significant difference in the positive rate of PFO detected by TTE and TEE(χ^(2)=0.534,P=0.465 for gradeⅠ;χ^(2)=1.366,P=0.243 for gradeⅡ,respectively).The positive rates of c-TTE and c-TCD were significantly higher than those of TTE(P=0.001)and TEE(P=0.005),and the difference was statistically significant.According toⅢgrade of PFO-RLS:the positive rates of c-TTE and c-TCD were consistent with those of TEE corresponding to grade III PFO,and were all significantly higher than those of TTE(χ^(2)=27.230,P<0.001),with statistical significance.Total number of positive PFO detections:there was no significant difference in the positive rates of c-TTE and c-TCD(χ^(2)=0.086,P=0.770),while the positive rates of c-TTE were significantly higher than those of TTE(χ^(2)=79.385,P<0.001)and TEE(χ^(2)=15.445,P<0.001).The positive rate of c-TCD was significantly higher than that of TTE(χ^(2)=76.222,P<0.001)and TEE(χ^(2)=13.572,P<0.001),and the difference was statistically significant.TEE positive rate was significantly higher than TTE positive rate(χ^(2)=33.222,P<0.001).The diagnosis of c-TCD and c-TTE was consistent in 50 cases and inconsistent in 13 cases.Conclusion c-TTE and c-TCD should be the first choice for PFO-RLS detection and should be checked simultaneously.