不同状态下c-TTE检查在卵圆孔未闭诊断中的价值  

Diagnostic value of c-TTE in patent foramen ovale under different states

作　　者：李文华 孙艳丹 苏军芳 邓剑平 胡运 LI Wen-hua;SUN Yan-dan;SU Jun-fang;DENG Jian-ping;HU Yun(Department of Ultrasound,986th Air Force Hospital,Xi'an 710054;Department of Neurosurgery,the Second Affiliated Hospital of Air Force Military Medical University;Department of Ultrasound,Xijing Hospital,Xi'an 710032,Shaanxi,China)

机构地区：[1]空军第九八六医院超声科,陕西西安710054 [2]空军军医大学学第二附属医院神经外科 [3]西京医院超声科,陕西西安710032

出　　处：《川北医学院学报》2024年第10期1325-1328,共4页Journal of North Sichuan Medical College

基　　金：陕西省重点研发计划项目(2023-YBSF-096)。

摘　　要：目的:探讨不同状态下经胸右心声学造影(c-TTE)检查在卵圆孔未闭(PFO)的诊断价值。方法:选取因隐源性脑卒中或偏头痛就诊的86例可疑PFO患者作为研究对象,患者均接受c-TTE、经食道超声心动图(TEE)检查,以TEE为PFO的诊断金标准,测量PFO直径大小,分析咳嗽动作(CM)、Valsalva动作(VM)和改良VM下c-TTE对PFO的诊断价值,并比较以上不同状态下右向左分流(RLS)微气泡初始出现心动周期分布和分级差异,分析PFO直径与RLS微气泡初始出现心动周期和分级相关性。结果:86例可疑PFO患者经TEE确诊50例PFO;c-TTE CM状态下诊断PFO 48例,灵敏度为96.00%、特异度为83.33%,准确度为90.70%,Kappa值为0.806;VM状态下诊断PFO 45例,灵敏度为90.00%、特异度为88.89%,准确度为89.53%,Kappa值为0.786;改良VM状态下诊断PFO 50例,灵敏度为100.00%、特异度为94.44%,准确度为97.67%,Kappa值为0.952。其中,改良VM诊断PFO的准确度高于CM、VM(P<0.05);与CM比较,VM、改良VM状态下,RLS微气泡初始出现时间分布在<3个心动周期更多,RLS分级在4级的更多(P<0.05)。RLS分级与PFO直径正相关(P<0.05)。结论:不同状态下c-TTE检查对PFO均具有较好的诊断效能,而与CM比较,VM、改良VM状态下可能更易捕捉到RLS,且改良VM诊断PFO价值更高。Objective:To explore the diagnostic value of contrast transthoracic echocardiography(c-TTE)in patent foramen ovale(PFO)under different states.Methods:86 patients with suspicious PFO presenting to cryptogenic stroke or migraine were selected,and all underwent c-TTE and transesophageal echocardiography(TEE).Taking TEE as the golden standard,diameter of PFO was measured.The diagnostic value of c-TTE for PFO under cough motion(CM),Valsalva motion(VM)and modified VM was analyzed,and differences in cardiac cycle distribution and grading of right-to-left shunt(RLS)microbubble initially appearing under the above different states were compared.The correlation between PFO diameter and cardiac cycle,grading of RLS microbubble initially appearing was analyzed.Results:In the 86 patients with suspected PFO,TEE showed that there were 50 confirmed cases.Under CM state,c-TTE showed that there were 48 cases with PFO,its sensitivity,specificity,accuracy and Kappa value were 96.00%,83.33%,90.70%and 0.806,respectively.Under VM state,c-TTE showed that there were 45 cases with PFO,its sensitivity,specificity,accuracy and Kappa value were 90.00%,88.89%,89.53%and 0.786,respectively.Under modified VM state,c-TTE showed that there were 50 cases with PFO,its sensitivity,specificity,accuracy and Kappa value were 100.00%,94.44%,97.67%and 0.952,respectively.The diagnostic accuracy of PFO under modified VM state was higher than that under CM and VM state(P<0.05).Compared with CM state,proportions of RLS microbubble initially appearing time<3 cardiac cycles and RLS grading at grade 4 were higher under VM state and modified VM state(P<0.05).RLS grading was positively correlated with PFO diameter(P<0.05).Conclusion:c-TTE has good diagnostic efficiency for PFO under different states.Compared with CM state,c-TTE may be more easily capture RLS under VM state and modified VM state,and diagnostic value of c-TTE is higher for PFO under modified VM state.

关 键 词：经胸右心声学造影 卵圆孔未闭 咳嗽动作 VALSALVA动作 改良Valsalva动作 

分 类 号：R541[医药卫生—心血管疾病]