Comparison of the application value of mVM and calf muscle tension motion in the diagnosis of patent foramen ovale by cTTE
Objective To compare the application value of modified Valsalva maneuver(mVM)and calf muscle tension motion in the diagnosis of patent foramen ovale(PFO)by contrast transthoracic echocardiography(cTTE).Method 87 suspected PFO patients admitted to Nanjing First Hospital Affiliated to Nanjing Medical University from June 2022 to June 2023 were selected as the study objects.All patients underwent transesophageal echocardiography(TEE)combined with cTTE examination to determine the source of right-to-left shunt(RLS),and were divided into PFO group(presence of abnormal blood flow)and normal group according to whether microbubbles appeared in the left heart and the initial time of microbubbles,and the clinical data of the two groups were compared and analyzed.All patients underwent cTTE under quiet state,mVM and calf muscle tension respectively.The detection rate of PFO,the initial cardiac cycle of RLS microbubbles and the detection degree of RLS shunt volume in cTTE under these three auxiliary states were compared and analyzed.Result Using TEE combined with cTTE examination as the gold standard,68 cases of 87 suspected PFO patients were examined in PFO group,including 23 cases of small RLS,7 cases of medium RLS,38 cases of large RLS,and 19 cases of normal group.The comparison of clinical data between the two groups showed that the age of PFO group was smaller than that of normal group,and the proportion of headache symptoms was higher than that of normal group,with statistical significance(P＜0.05).Compared with the quiet state,the positive detection rate of PFO in mVM and calf muscle tension movement was higher,and the initial cardiac cycle of RLS microbubbles was earlier,with statistical significance(P＜0.05).There was no significant difference in the positive rate of PFO and the initial cardiac cycle of RLS microbubbles between mVM and calf muscle tension(P＞0.05).There was significant difference in the detection rate of a small amount of RLS under quiet state,mVM and calf muscle tension(P＜0.05),but there was no significant difference in the detection rate of a large amount of RLS between medium and large amounts of RLS(P＞0.05).Consistency test results showed that there was no statistical significance in the specificity of PFO detected under quiet state,mVM and calf muscle tension movements(P＞0.05),but the sensitivity and Kappa value of PFO detected under mVM and calf muscle tension movements were significantly higher than those under quiet state(P＜0.05),and the Kappa value of mVM was the largest.The PFO results are most consistent with the actual results.Conclusion mVM and calf muscle tension are effective auxiliary ways for cTTE to diagnose PFO,especially mVM has the strongest clinical significance in assisting cTTE diagnosis.Calf muscle tension is a simple and effective auxiliary action for the diagnosis of PFO.For mVM patients who cannot perform effectively,calf muscle tension can replace mVM to a certain extent.
万方数据
维普
