c-TCD联合c-TTE在卵圆孔未闭右向左分流诊断中的应用
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摘要
目的探讨联合应用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),对诊断卵圆孔未闭(PFO)相关的右向左分流(RLS)的临床价值。方法纳入2016-01—2018-10,至郑州大学附属洛阳中心医院神经内科就诊的隐源性脑卒中患者及偏头痛患者413例,同时行c-TCD联合c-TTE检查,对两者方法的检出差异和分流等级差异进行比较。进一步选取两种检查方法均阳性且c-TCD分级为2～3级,并拟进一步治疗的40例患者行TEE检查。结果 413例入组者中c-TCD和c-TTE检查RLS阳性率分别为44.07%、41.67%,差异有统计学意义(P<0.01)。c-TCD和c-TTE方法检查RLS分级结果有统计学差异(Bowker值14.106,P=0.028),c-TCD检出级别高。40例行TEE检查的患者,均发现存在卵圆孔未闭。结论 c-TCD方法检查RLS敏感性高。c-TCD和c-TTE联合检查方法可提高PFO-RLS诊断的准确性。
Objective Comparison of c-TTE and c-TCD and the combined application of the two methods indetecting PFO-RLS.Methods 413 volunteers were participated in the project research when they were diagnosed as CS and migraine at the Department of Neurology,Luoyang Center Hospital Affiliated to Zhengzhou University during the period from January 2016 to October 2018.Combined application of c-TCD and c-TTE detections were conducted to all the volunteers to compare the differences in detection rates and grades of RLS.40 cases with positive c-TCD and c-TTE results,2～3 level of c-TCD grade and willingness to receive further treatment were examined by TEE.Results RLS positive results by c-TCD and c-TTE were respectively 44.07% and 41.67%,and hence the difference had statistical significance(P<0.01).The results of RLS grades between c-TCD and c-TTE were statistically significant(Bowker test value is 14.106,P =0.028),with the grades of the former method higher than the latter.A TEE test found out PFO in all of 40 participants.Conclusion Compared with c-TTE method,c-TCD method is more sensitive to finding RLS.The combined application of c-TCD and c-TTE improves the accuracy in diagnosing RLS and hence can serve as an efficient screening tool for PFO-RLS.At the same time,it is safe and non-invasive.
Objective Comparison of c-TTE and c-TCD and the combined application of the two methods indetecting PFO-RLS.Methods 413 volunteers were participated in the project research when they were diagnosed as CS and migraine at the Department of Neurology,Luoyang Center Hospital Affiliated to Zhengzhou University during the period from January 2016 to October 2018.Combined application of c-TCD and c-TTE detections were conducted to all the volunteers to compare the differences in detection rates and grades of RLS.40 cases with positive c-TCD and c-TTE results,2～3 level of c-TCD grade and willingness to receive further treatment were examined by TEE.Results RLS positive results by c-TCD and c-TTE were respectively 44.07% and 41.67%,and hence the difference had statistical significance(P<0.01).The results of RLS grades between c-TCD and c-TTE were statistically significant(Bowker test value is 14.106,P =0.028),with the grades of the former method higher than the latter.A TEE test found out PFO in all of 40 participants.Conclusion Compared with c-TTE method,c-TCD method is more sensitive to finding RLS.The combined application of c-TCD and c-TTE improves the accuracy in diagnosing RLS and hence can serve as an efficient screening tool for PFO-RLS.At the same time,it is safe and non-invasive.
引文
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[21] 宋彬彬,段智慧,杜艳娇,等.不明原因中青年脑梗死RLS诊断cTCD和cTTE对比研究[J].中国实用神经疾病杂志,2017,20(24):25-31.
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[2] SUSURI N,OBEID S,ULMI M,et al.Second transcatheter closure for residual shunt following percutaneous closure of patent foramen ovale[J].EuroIntervention,2017,13(7):858-866.
[3] ARAL M,MULLEN M.The Flatstent versus the conventional umbrella devices in the percutaneous closure of patent foramen ovale[J].Catheter Cardiovasc Interv,2015,85(6):1 058-1 065.
[4] RIGATELLI G,DELL'AVVOCATA F,DAGGUBATI R,et al.Impact of interatrial septum anatomic features on short- and long-term outcomes after transcatheter closure of patent foramen ovale:single device type versus anatomic-driven device selection strategy[J].J Interv Cardiol,2013,26(4):392-398.
[5] NING M,LO E H,NING P C,et al.The brain's heart - therapeutic opportunities for patent foramen ovale (PFO) and neurovascular disease[J].Pharmacol ther,2013,139(2):111-123.
[6] SNIJDER R J,LUERMANS J G,DE HEIJ A H,et al.Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura:A Large Observational Study[J].J Am Heart Assoc,2016,5(12).pii:e003771.
[7] JIANG X H,WANG S B,TIAN Q,et al.Right-to-left shunt and subclinical ischemic brain lesions in Chinese migraineurs:a multicentre MRI study[J].BMC Neurol,2018,18(1):18.
[8] MOJADIDI M K,ROBERTS S C,WINOKER J S,et al.Accuracy of transcranial Doppler for the diagnosis of intracardiac right-to-left shunt:a bivariate meta-analysis of prospective studies[J].JACC Cardiovasc Imaging,2014,7(3):236-250.
[9] KATSANOS A H,PSALTOPOULOU T,SERGENTANIS T N,et al.Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia:A systematic review and diagnostic test accuracy meta-analysis[J].Ann Neurol,2016,79(4):625-635.
[10] ADAMS H P Jr,BENDIXEN B H,KAPPELLE L J,et al.Classification of subtype of acute ischemic stroke.Definitions for use in a multicenter clinical trial.TOAST.Trial of Org 10172 in Acute Stroke Treatment[J].Stroke,1993,24(1):35-41.
[11] Headache Classification Committee of the International Headache Society (IHS).The International Classifcation of Headache Disorders,3rd edition(beta version)[J].Cephalalgia,2013,33:629-808.
[12] DUAN Z H,YANG Z Y,SONG B B,et al.Transorbital Doppler with carotid siphon monitoring detects right-to-left shunteffectively[J].Neurol Res,2018,40(3):197-203.
[13] JAUSS M,ZANETTE E.Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography[J].Cerebrovasc Dis,2000,10(6):490-496.
[14] LI L,YIIN G S,GERAGHTY O C,et al.Incidence,outcome,risk factors,and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke:a population-based study[J].Lancet Neurol,2015,14(9):903-913.
[15] MOJADIDI M K,WINOKER J S,ROBERTS S C,et al.Accuracy of conventional transthoracic echocardiography for the diagnosis of intracardiac right-to-left shunt:a meta-analysis of prospective studies[J].Echocardiography,2014,31(9):1 036-1 048.
[16] BAHER A,MOWLA A,KODALI S,et al.Cardiac MRI improves identification of etiology of acute ischemic stroke[J].Cerebrovasc Dis,2014,37(4):277-284.
[17] PAGáN R J,PARIKH P P,MERGO P J,et al.Emerging role of cardiovascular CT and MRI in the evaluation of stroke[J].AJR Am J Roentgenol,2015,204(2):269-280.
[18] TOBE J,BOGIATZI C,MUNOZ C,et al.Transcranial Doppler is Complementary to Echocardiography for Detection and Risk Stratification of Patent Foramen Ovale[J].Can J Cardiol,2016,32(8):986.e9-986.e16.
[19] MAFFè S,DELLAVESA P,ZENONE F,et al.Transthoracic second harmonic two- and three-dimensional echocardiography for detection of patent foramen ovale[J].Eur J Echocardiogr,2010,11(1):57-63.
[20] ZHAO E,WEI Y,ZHANG Y,et al.A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver[J].Medicine,2015,94(43):e1937.
[21] 宋彬彬,段智慧,杜艳娇,等.不明原因中青年脑梗死RLS诊断cTCD和cTTE对比研究[J].中国实用神经疾病杂志,2017,20(24):25-31.
[22] ZAHURANEC D B,MUELLER G C,BACH D S,et al.Pilot study of cardiac magnetic resonance imaging for detection of embolic source after ischemic stroke[J].J Stroke cerebrovasc Dis,2012,21(8):794-800.