经食道超声心动图右心声学造影中应用手振加血激活生理盐水显影对卵圆孔未闭的诊断价值
Value of hand vibration and blood activated saline in the diagnosis of patent foramen ovale in right echocardiography by transesophageal echocardiography
曹静 1郭丽焱1
作者信息
- 1. 041000 山西省临汾市,临汾市人民医院超声科
- 折叠
摘要
目的 探讨经食道超声心动图右心声学造影(TEE-cTTE)中应用手振加血激活生理盐水(ASB)显影对卵圆孔未闭(PFO)的诊断价值.方法 选取2020年7月至2023年1月临汾市人民医院疑似PFO患者106例,根据相关诊断标准分为PFO组(78例)与非PFO组(28例),均行TEE-cTTE检查,根据造影剂类型分为ASB、手振激活50％葡萄糖溶液(AGB)、手振激活生理盐水(AS),对比3种造影剂右心开始显影到微气泡逐渐减少到每帧图像低于10个微气泡的时间(T-R)、两组卵圆孔内径和隧道长度,分析3种造影剂行TEE-cTTE检查对PFO、PFO类型及右向左分流(RLS)的诊断价值.结果 ASB静息状态下、Valsalva动作下T-R长于AGS、AS,AGS静息状态下、Valsalva动作下T-R长于AS(P＜0.05);3种造影剂检测PFO组卵圆孔内径长于非PFO组(P＜0.05);ASB、AGS检测的PFO组卵圆孔内径长于AS检测(P＜0.05);ROC曲线分析,ASB 行 TEE-cTTE 诊断 PFO 的 AUC 为 0.872(95％CI 0.793～0.929),敏感度为 92.31％(72/78),特异度为82.14％(23/28);AGS 行 TEE-cTTE 诊断 PFO 的 AUC 为 0.842(95％CI0.758～0.905),敏感度为 89.74％(70/78),特异度为 78.57％(22/28);AS 行 TEE-cTTE 诊断 PFO 行 TEE-cTTEAUC 为 0.672(95％CI 0.574～0.760),敏感度为 80.77％(63/78),特异度为 53.57％(15/28),提示 ASB、AGS 行 TEE-cTTE 诊断 PFO 的价值优于 AS;ASB行TEE-cTTE检查诊断PFO类型、RLS分级与临床诊断结果的一致性较高(Kapp值=0.819、0.838);AGS行TEE-cTTE检查诊断PFO类型、RLS分级与临床诊断结果的一致性一般(Kapp值=0.653、0.655);AS行TEE-cTTE检查诊断PFO类型与临床诊断结果的一致性较差(Kapp值=0.393),诊断RLS分级与临床诊断结果的一致性一般(Kapp值=0.480).结论 TEE-cTTE检查中应用ASB显影能延长T-R时间,提高PFO诊断价值,且在诊断PFO类型、RLS分级方面表现出与临床诊断结果较高的一致性,有利于开展具有针对性、科学性的临床诊治工作.
Abstract
Objective To evaluate the value of hand vibration and blood activated saline(ASB)in the diagnosis of patent foramina ovale(PFO)in right heart echocardiography(TEE-cTTE).Methods A total of 106 patients with suspected PFO in Linfen People's Hospital from July 2020 to January 2023 were selected and divided into the PFO group(78 cases)and non-PFO group(28 cases)according to relevant diagnostic criteria.All the patients underwent TEE-cTTE examination and were divided into ASB,hand-activated 50％glucose solution(AGS)and hand-activated saline(AS)according to the type of contrast agent.The time from the start of right heart imaging to the gradual decrease of microbubbles to less than 10 microbubbles per frame image(T-R),the diameter and the length of the foramen ovale tunnel in both groups were compared for the three contrast agents.The diagnostic value of TEE-cTTE examination with three contrast agents for PFO,PFO type and right-to-left shunt(RLS)was analyzed.Results T-R was longer in ASB resting state and Valsalva movement than in AGS and AS;T-R was longer in AGS resting state and Valsalva movement than in AS(P＜0.05).The diameter of foramen ovale in PFO group was larger than that in non-PFO group(P＜0.05).The diameter of foramen ovale in PFO group measured by ASB and AGS was larger than that measured by AS(P＜0.05).ROC curve analysis showed that the AUC of TEE-cTTE diagnosis of PFO in ASB was 0.872(95％CI:0.793～0.929),the sensitivity was 92.31％(72/78)and the specificity was 82.14％(23/28);the AUC in AGS for the diagnosis of PFO by TEE-cTTE was 0.842(95％CI:0.758～0.905),the sensitivity was 89.74％(70/78)and the specificity was 78.57％(22/28);the AUC in AS for the diagnosis of PFO by TEE-cTTEAUC was 0.672(95％CI:0.574～0.760),the sensitivity was 80.77％(63/78)and the specificity was 53.57％(15/28).It suggesting that ASB and AGS were better than AS in diagnosing PFO.The type of PFO and RLS grade diagnosed by TEE-cTTE on ASB were consistent with the clinical diagnosis results(Kapp value=0.819,0.838).The type of PFO and RLS grade diagnosed by TEE-cTTE examination in AGS were generally consistent with the clinical diagnosis results(Kapp value=0.653,0.655).The consistency between PFO type diagnosed by TEE-cTTE in AS and the clinical diagnosis results was poorer(Kapp value=0.393),and the consistency between the diagnostic RLS grade and the clinical diagnosis results was general(Kapp value=0.480).Conclusion The application of ASB imaging in TEE-cTTE examination can prolong T-R time,improve the diagnostic value for PFO and show a high consistency with clinical diagnosis results in the diagnosis of PFO types and RLS classification,which is conducive to carrying out targeted and scientific clinical diagnosis and treatment.
关键词
卵圆孔未闭/右向左分流/经食道超声心动图/右心声学造影/手振加血激活生理盐水/诊断价值Key words
Patent foramen ovale/Right-to-left shunt/Transesophageal echocardiography/Right echography/Hand vibration and blood activate normal saline/Diagnostic value引用本文复制引用
出版年
2024
NETL
NSTL
万方数据