Int J Cardiol 2011 Oct;152 (1): 24-7. [IF:6.802]
Enhanced detection of patent foramen ovale by systematic transthoracic saline contrast echocardiography.
Lam YY , Yu CM , Zhang Q , Yan BP , Yip GW .
Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Peoples’ Republic of China.
香港中文大学内科及药物治疗系，香港威尔斯亲王医院心脏病科
Abstract
We aimed to evaluate the effectiveness of transthoracic saline contrast echocardiography (TSCE) in detecting patent foramen ovale (PFO). Transesophageal echocardiography (TEE) is semi-invasive and not ideal for PFO screening. 112 patients (48 males, 46 ± 14 years) with suspected PFO received intravenous agitated-saline contrast at rest and stress (strain and release phases of Valsalva maneuver and coughing). The presence of interatrial shunting was defined as >5 bubbles appearing in the left heart within 3 cardiac cycles. The stage of the maneuver at which interatrial shunting occurred was recorded. The TSCE findings were validated by TEE. TEE identified PFO in 45% of patients. The sensitivities of TSCE in detecting PFO at rest, during strain and release of Valsalva maneuver, and coughing were 12.0%, 38.0%, 80.0% and 94.0% respectively (each p<0.05 when compared to previous stage). Specificities were similar and >95% for all stages. Moreover, the release phase of the maneuver improved the diagnostic accuracy [defined as (number of true positives+true negatives) divided by total in sample] with incremental value over the preceding strain phase (89.2 vs. 70.5%, p<0.001). Patent foramen ovale can be identified confidently with proper conduct of the Valsalva maneuver during the transthoracic saline contrast echocardiography.
摘要
目的:本文旨在评估生理盐水造影超声心动图(TSCE)检测卵圆孔未闭(PFO)的的有效性.方法:经食管超声心动图(TEE)是一种半侵入性的、非理想化的PFO扫描手段.选取112例可疑PFO患者(包括了48例男性,年龄在46 ± 14岁)分别在休息、Valsalva动作的应变和释放期、咳嗽四种状态下接受经静脉生理盐水造影.在3次心脏循环过程中,左心房出现>5个气泡即认为存在心房分流.记录下Valsalva动作心房分流发生的时间点,并通过TEE验证TSCE的结果.结果:TEE诊断45%的病人患有PFO.在四种状态下TSCE检测PFO的敏感度分别为12.0%, 38.0%, 80.0%和94.0%(p<0.05).不同状态下的特异度相似且都>95%.此外,Valsalva动作释放期的诊断率(利用所有样本计算真阳性和真阴性)较应变期要高(89.2 vs. 70.5%, p<0.001).结论:配合适当的Valsalva动作TESC可靠检测出PFO。
