Clinical application value of contrast transthoracic echocardiography in screening patent foramen ovale with right to left shunt
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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。 -
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
Abstract: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. -
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