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|本期目录/Table of Contents|

经颅多普勒超声声学造影与经胸超声心动图造影对卵圆孔未闭右向左分流诊断的比较

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第4期
页码:
390-393
栏目:
结构性心脏病
出版日期:
2015-04-20

文章信息/Info

Title:
Comparison of contrast transcranial Doppler ultrasonography and contrast transthoracic echocardiography for detecting right to left shunt in patients with patent foramen ovale
作者:
王宇星1; 2; 宋 强2; 刘维军1; 张玉顺2
(1.青海大学附属医院心血管内科，青海 西宁 810001；
2.西安交通大学第一附属医院心内二科，陕西 西安 710061)
Author(s):
WANG Yu-xing1; 2;  SONG Qiang2;  LIU Wei-jun1;  ZHANG Yu-shun2
(1.Department of Cardiology, Affiliated Hospital, Qinghai University, Xining 810001, Qinghai, China；
2.Second Department of Cardiology, First Affiliated Hospital, Medical College, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China)
关键词:
卵圆孔未闭; 右向左分流; 经胸超声心动图造影; 经颅多普勒超声声学造影
Keywords:
patent foramen ovale;  right-to-left shunt;  contrast transthoracic echocardiography;  contrast transcranial Doppler ultrasonography
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 比较经颅多普勒超声声学造影(c-TCD)和经胸超声心动图声学造影（c-TTE）对卵圆孔未闭(PFO)右向左分流(RLS)的诊断。方法 选取PFO伴反常栓塞患者195例，均接受c-TTE和c-TCD检查。经肘前静脉注射激活盐水对比剂，观察记录PFO-RLS微泡数量并进行半定量分级。对上述2种检查至少1种结果为阴性的58例患者进一步行经食管超声心动图声学造影（c-TEE），以c-TEE的结果作为标准，分别对2种检查结果进行对照分析。结果 195例患者c-TCD和c-TTE对PFO- RLS的检出率分别为75.9%（148/195）、88.2%（172/195），差异有统计学意义（P<0.05）。对2种检查PFO-RLS半定量分级的χ2检验显示，Ⅰ级c-TCD阳性检出率高于c-TTE，差异有统计学意义（P<0.01）；Ⅱ级c-TCD阳性率稍高于c-TTE，但差异未达到显著水平；Ⅲ级和Ⅳ级c-TTE阳性率高于c-TCD，差异有统计学意义（P<0.05）。195例患者中，有58例 c-TCD或c-TTE结果为阴性并进行了c-TEE检查。以c-TEE结果作为标准，对比上述2种检查的准确性，结果显示c-TCD与c-TEE结果有显着差异，差异有统计学意义（P<0.01），c-TTE与 c-TEE结果较为接近，差异无统计学意义。结论 c-TTE 对 PFO-RLS 的检出阳性率优于 c-TCD，可以作为临床筛查PFO的首选方法。
Abstract:
AIM To compare contrast transcranial Doppler ultrasonography (c-TCD) and transthoracic contrast echocardiography (c-TTE) for detecting right to left shunt (RLS) in patients with patent foramen ovale (PFO). METHODS The prospective study was conducted in 195 PFO patients who suffered from paradoxical embolism. Both c-TCD and c-TTE were performed for all the patients. Fifty-eight patients with negative results from either c-TCD or c-TTE were further examined by contrast transesophageal echocardiography (c-TEE). The severity of RLS was semi-quantitatively assessed by scaling the numbers of microbubbles (MBs) in the left atrium. Using c-TEE as the reference standard, we analyzed the results of c-TCD and c-TTE. RESULTS c-TTE demonstrated a significantly higher sensitivity for detection of RLS than c-TCD (88.2% vs. 75.9%, P<0.05). The comparison of semi-quantitative grading derived from c-TCD and c-TTE was also significantly different. The positive rate of c-TCD of grade Ⅰ was significantly higher than the positive rate of c-TTE (P<0.01). The positive rate of c-TCD of grade Ⅱ was higher than the positive rate of c-TTE, but with no statistical difference (P>0.05). The positive rates of c-TCD of grade Ⅲ and Ⅳ were both lower than the positive rates of c-TTE (P<0.05). In the 58 patients who were further examined by c-TEE, it was found that the difference in detection rate between c-TCD and c-TEE was significantly different (P<0.01), while the results of c-TTE and c-TEE had a good consistency (P>0.05). CONCLUSION c-TTE is more effective in detection of RLS than c-TCD and can be used as a recommended technique for screening PFO in clinical practice.

参考文献/References

[1]Hagen PT,Scholz DG,Edwards WD.Incidence and size of patent foramen ovale during the first 10 de-cades of life:an autopsy study of 965 normal hearts[J].Mayo Clin Proc,1984,59(1):17-20.
[2]Sharma A,Gheewala N,Silver P.Role of patent foramen ovale in migraine etiology and treatment: A review[J].Echocardiography,2011,28(8):913-917.
[3]Handke M,Harloff A,Olschewski M,et al.Patent foramen ovale and cryptogenic stroke in older patients[J].N Engl J Med,2007,357(22):2262-2268.
[4]Soliman OI,Geleijnse ML,Meijboom FJ,et al.The use of contrast echocardiography for the detection of cardiac shunts[J].Eur J Echocardiogr,2007,8(3):S2-S12.
[5]Kernan WN,Ovbiagele B,Black HR,et al.American stroke association. guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160-2236.
[6]Headache Classification Committee of the International Headache Society(IHS).The International Classification of Headache Disorders,3rd edition (beta version)[J].Cephalalgia,2013,33(9):629-808.
[7]Webster MW,Chancellor AM,Smith HJ,et al.Patent foramen ovale in young stroke patients[J].Lancet,1988,2(8601):11-12.
[8]Schuchlenz HW,Weihs W,Horner S,et al.The association between the diameter of a patent foramen ovale and the risk of embolic cerebrovascular events[J].Am J Med,2000,109(6):456-462.
[9]Lamy C,Giannesini C,Zuber M,et al.Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale:the PFO-ASA Study[J].Stroke,2002,33(3):706-711.
[10]Carcagni A,Di Sciascio G.Echocardiography in patent foramen ovale[J].G Ital Cardiol(Rome),2006,7(8):516-522.
[11]Marriott K,Manins V,Forshaw A,et al.Detection of right-to-left atrial communication using agitated saline contrast imaging: experience with 1162 patients and recommendations for echocardiography[J].J Am Soc Echocardiogr,2013,26(1):96-102.
[12]Lam YY,Yu CM,Zhang Q,et al.Enhanced detection of patent foramen ovale by systematic transthoracic saline contrast echocardiography[J].Int J Cardiol,2011,152(1):24-27.
[13]张玉顺,何 璐,成革胜,等.TEE联合c-TCD检测小型卵圆孔未闭RLS[J].心脏杂志,2013,25(3):277-283.
[14]De Castro S,Cartoni D,Fiorelli M,et al.Morphological and functional characteristics of patent foramen ovale and theirembo licimp lications[J].Stroke,2000,31(10):2407-2413.

备注/Memo

备注/Memo:
收稿日期：2015-03-13.
通讯作者：张玉顺，教授，主要从事结构性心脏病研究 Email:zys2889@sina.com
共同通讯作者：刘维军，主任医师，主要从事心脏介入治疗研究 Email:qhliuweijun@sina.com
作者简介：王宇星，硕士生 Email:wangyuxing86@126.com
更新日期/Last Update: 2015-04-22