Schuchlenz Herwig Walter, Weihs Wolfgang, Hackl Elisabeth, Rehak Peter
Medical Department II, Göstingerstrasse 22, LKH Graz-West Hospital, A-8020 Graz, Austria.
Int J Cardiol. 2006 May 24;109(3):375-80. doi: 10.1016/j.ijcard.2005.06.022. Epub 2005 Jul 14.
Transesophageal contrast echocardiography (cTEE) is considered to be the method of choice for diagnosing patent foramen ovale (PFO), but its diagnostic accuracy compared with color Doppler guided TEE in the presence of an Eustachian valve (EV) has not been evaluated. The main aim of this study was to assess the diagnostic accuracy for PFO diagnosis of color Doppler TEE at low pulse repetition frequency.
We ascertained the presence of PFO and EV using cTEE and transthoracic contrast echocardiography (cTTE) in 292 consecutive patients (age 42+/-12 years) with cryptogenic stroke. A diagnosis of PFO was based on the observation of right-to-left shunting of contrast bubbles or by color Doppler with pulse repetition frequency of 20-30 cm/s. An EV with a diameter of >1.5 cm in the bicaval view was considered large.
Overall 204 patients (70%) had evidence of a right-to-left shunt by either contrast echo method. Shunting was demonstrated more frequently by color Doppler than by cTEE, either spontaneously (133 vs. 92; p=0.01) or during provocative maneuvers (166 vs. 184; p=0.01). The sensitivity of color Doppler was significantly higher than that of cTEE (90% vs. 81%; p=0.01). A large EV was found in 37 patients, 31 (84%) of whom had a PFO. The presence of a large EV did not significantly influence the sensitivity of color Doppler for detecting shunting through a PFO, but the sensitivity of cTTE and cTEE was significantly reduced (from 88% to 42%, p<0.001).
Color Doppler TEE is more accurate than traditional cTEE for PFO diagnosis and is not negatively influenced by the presence of an EV, provided that a low pulse repetition frequency is used.
经食管对比超声心动图（cTEE）被认为是诊断卵圆孔未闭（PFO）的首选方法，但在存在欧氏瓣（EV）的情况下，其与彩色多普勒引导的经食管超声心动图（TEE）相比的诊断准确性尚未得到评估。本研究的主要目的是评估低脉冲重复频率下彩色多普勒TEE对PFO诊断的准确性。
我们使用cTEE和经胸对比超声心动图（cTTE）对292例连续的不明原因卒中患者（年龄42±12岁）进行检查，以确定PFO和EV的存在。PFO的诊断基于观察到对比剂气泡从右向左分流或通过脉冲重复频率为20-30cm/s的彩色多普勒检查。在双腔静脉视图中直径>1.5cm的EV被认为是大的。
总体而言，204例患者（70%）通过两种对比回声方法中的任何一种都有从右向左分流的证据。彩色多普勒显示分流比cTEE更频繁，无论是自发分流（133例对92例；p=0.01）还是在激发动作时（166例对184例；p=0.01）。彩色多普勒的敏感性显著高于cTEE（90%对81%；p=0.01）。在37例患者中发现了大的EV，其中31例（84%）有PFO。大EV的存在并没有显著影响彩色多普勒检测通过PFO分流的敏感性，但cTTE和cTEE的敏感性显著降低（从88%降至42%，p<0.001）。
彩色多普勒TEE在诊断PFO方面比传统的cTEE更准确，并且在使用低脉冲重复频率的情况下不受EV存在的负面影响。
