基于经食管超声心动图及经胸右心声学造影的模型预测卵圆孔未闭相关脑卒中风险的临床价值
Clinical value of the model based on transesophageal echocardiography and contrast transthoracic echocardiography in predicting the risk of patent foramen ovale-associated stroke
许敏 1廖依依 1左浩 1李春 1荣亚妮 1管雪 1余璞 2高云华 1徐亚丽1
作者信息
- 1. 400037 重庆市,陆军军医大学第二附属医院超声科
- 2. 重庆市长寿区人民医院超声科
- 折叠
摘要
目的 应用经食管超声心动图(TEE)观察卵圆孔未闭(PFO)的解剖特征,联合经胸右心声学造影(cTTE)评估PFO所致右向左分流(RLS),构建PFO相关脑卒中风险预测模型并探讨其预测效能.方法 选取我院经TEE联合cTTE确诊为PFO合并RLS的中青年患者105例,根据是否合并缺血性脑卒中分为卒中组47例和非卒中组58例.应用TEE观察是否合并希阿里氏网或下腔静脉瓣、房间隔瘤,测量房间隔活动度、PFO通道长度、PFO与下腔静脉角度,于Valsalva动作下测量PFO左房侧开口径、右房侧开口径;cTTE检查时依据静止的单帧图像上左心腔内最大微泡数量对静息状态及Valsalva动作下RLS进行分级,比较两组上述检查结果和临床资料的差异.采用二元Logistic回归分析预测中青年PFO相关脑卒中发生的独立影响因素,并建立风险预测模型;采用Hosmer-Lemeshow检验评价该模型的拟合度;绘制受试者工作特征(ROC)曲线评价该模型的区分度.结果 两组年龄、男性占比、合并房间隔瘤占比、PFO左房侧开口径及右房侧开口径比较,差异均有统计学意义(均P<0.05);两组合并阿里氏网或下腔静脉瓣占比、房间隔活动度、PFO通道长度、PFO与下腔静脉角度,以及静息状态和Valsalva动作下RLS分级、中大量分流(RLSⅡ、Ⅲ级)占比及静息状态下存在RLS占比比较,差异均无统计学意义.二元Logistic回归分析显示,性别、PFO左房侧开口径均为预测PFO相关脑卒中发生的独立影响因素(均P<0.05).由此构建的风险预测模型经Hosmer-Lemeshow检验显示其拟合度好(χ2=1.295,P=0.972);ROC曲线显示其具有较高的区分度(曲线下面积=0.728,P<0.001).结论 TEE联合cTTE可准确识别PFO的解剖及分流特征,基于二者构建的风险预测模型在中青年PFO相关脑卒中发生风险中有一定的预测价值.
Abstract
Objective To observe the anatomical characteristics of patent foramen ovale(PFO)by transesophageal echocardiography(TEE),and to assess the right-to-left shunt(RLS)caused by PFO by contrast transthoracic echocardiography(cTTE).To construct a risk prediction model for PFO and PFO-associated stroke,and to explore its predictive performance.Methods A total of 105 young and middle-aged patients with PFO complicated with RLS confirmed by TEE combined with cTTE in our hospital were selected.They were divided into a stroke group(n=47)and a non-stroke group(n=58)according to the presence or absence of ischemic stroke.A presence of Chiari network(CN)or eustachian valve(EV),atrial septal aneurysm(ASA)were observed by TEE.The atrial septum mobility,PFO tunnel length,PFO-to-inferior vena cava angle and the left atrial and right atrial orifice diameters during Valsalva state were measured.The RLS was graded based on the maximum number of microbubbles in a single frame of the left heart cavity in resting and Valsalva states during cTTE examination.The differences of the above parameters and clinical data between the two groups were compared.Binary Logistic regression analysis was used to screen the influencing factors of PFO-associated stroke in young and middle-aged patients,and a risk prediction model was established.The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Receiver operating characteristic(ROC)curve was drawn to evaluate the discriminatory ability of the model.Results There were significant differences in age,proportion of male,proportion of concurrent ASA,PFO left atrial and right atrial orifice diameters between the two groups(all P<0.05).However,there were no significant differences in the proportion of CN or EV,atrial septum mobility,PFO tunnel length,PFO-to-inferior vena cava angle,RLS grade in resting and Valsalva states,proportion of moderate-to-large shunts(grades Ⅱ and Ⅲ),and the proportion of RLS in resting state.Binary Logistic regression analysis showed that gender and PFO left atrial orifice diameter were the independent influencing factors for predicting PFO-associated stroke(both P<0.05).The constructed risk prediction model showed good goodness of fit by Hosmer-Lemeshow test(χ2=1.295,P=0.972),ROC curve analysis showed that the model had a high discriminatory ability(area under the curve was 0.728,P<0.001).Conclusion TEE combined with cTTE can accurately identify anatomical and shunt characteristics of PFO.The risk prediction model constructed based on these two modalities has certain diagnostic value in predicting the risk of PFO-associated stroke in young and middle-aged individuals.
关键词
超声心动描记术,经食管/经胸右心声学造影/卵圆孔未闭/脑卒中Key words
Echocardiography,transesophageal/Contrast transthoracic echocardiography/Patent foramen ovale/Stroke引用本文复制引用
基金项目
陆军军医大学优秀人才项目(2019R038)
出版年
2024
NETL
NSTL
维普
万方数据