Teague S M, Sharma M K
University of Oklahoma Health Sciences Center, Cardiology Section, Oklahoma City.
Stroke. 1991 Jun;22(6):740-5. doi: 10.1161/01.str.22.6.740.
Contrast echocardiography has been shown to be a sensitive method for detecting patent foramen ovale in embolic stroke, implying paradoxical embolization. However, not all two-dimensional echocardiographic studies are of diagnostic quality, and direct evidence for paradoxical cerebral embolization remains lacking. We addressed these problems by simultaneously using transcranial Doppler ultrasound and contrast echocardiography to compare relative sensitivity and concordance in the detection of right-to-left vascular shunting. Forty-six patients with stroke, transient neurologic defect, or question of atrial septal defect underwent study at rest and during Valsalva strain. Two-dimensional echocardiography detected shunting in 26% at rest and 15% during Valsalva strain, whereas transcranial Doppler study returned rates of 41% and 41%, respectively. Concordance was 82% and 75%, respectively. Discordant studies almost always had evidence of paradoxical contrast embolization by transcranial Doppler and intermediate findings by two-dimensional echocardiography. Transcranial Doppler is a sensitive, unambiguous technique for the detection of anatomic substrates and target organ involvement in patients suspected to have paradoxical cerebral embolization.
对比增强超声心动图已被证明是检测栓塞性卒中患者卵圆孔未闭的一种敏感方法，提示存在反常栓塞。然而，并非所有二维超声心动图检查都具有诊断质量，目前仍缺乏反常脑栓塞的直接证据。我们通过同时使用经颅多普勒超声和对比增强超声心动图来比较检测右向左血管分流时的相对敏感性和一致性，从而解决了这些问题。46例患有卒中、短暂性神经功能缺损或存在房间隔缺损问题的患者在静息状态和瓦尔萨尔瓦动作时接受了检查。二维超声心动图在静息状态下检测到分流的比例为26%，在瓦尔萨尔瓦动作时为15%，而经颅多普勒检查的相应比例分别为41%和41%。一致性分别为82%和75%。不一致的检查结果几乎总是显示经颅多普勒有反常对比剂栓塞的证据，而二维超声心动图有中间结果。经颅多普勒是一种敏感、明确的技术，可用于检测疑似存在反常脑栓塞患者的解剖学基础和靶器官受累情况。
