Department of Medicine, University of Alberta, 2E3.13 Walter Mackenzie Centre, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada.
Stroke. 2011 May;42(5):1473-4. doi: 10.1161/STROKEAHA.110.608224. Epub 2011 Mar 24.
Contrast transthoracic echocardiography (TTCE) is used to screen hereditary hemorrhagic telangiectasia (HHT) patients for right-to-left shunts (RLS) associated with increased stroke risk. We hypothesized that contrast transcranial Doppler (TCDc), shown to be highly sensitive for detecting RLS in patent foramen ovale, will be as comparable to TTCE for screening HHT patients.
We compared TTCE and TCDc for detecting RLS in 12 patients with HHT who also underwent CT pulmonary studies to determine pulmonary arteriovenous malformation (PAVM) presence. The sensitivity and specificity of TTCE and TCDc in detecting PAVM were determined and the agreement between TTCE and TCDc in detecting RLS was assessed.
Both TTCE and TCDc had 100% sensitivity in detecting underlying PAVM; the specificity was 25% and 38%, respectively. The agreement in detecting RLS between TTCE and TCD was high (κ=0.76). TCD was well-tolerated with no immediate adverse or embolic events over the next 3 months.
TCDc offers a simple office-based alternative to TTCE for screening RLS associated with PAVM in HHT patients.
对比经胸超声心动图（TTCE）用于筛查遗传性出血性毛细血管扩张症（HHT）患者与增加卒中风险相关的右向左分流（RLS）。我们假设，经颅多普勒超声（TCDc）已被证明对卵圆孔未闭相关 RLS 的检测具有高度敏感性，其与 TTCE 相比用于 HHT 患者的筛查也具有可比性。
我们比较了 12 例 HHT 患者的 TTCE 和 TCDc 用于检测 RLS 的情况，这些患者还接受了 CT 肺动脉研究以确定肺动静脉畸形（PAVM）的存在。确定了 TTCE 和 TCDc 检测 PAVM 的敏感性和特异性，并评估了 TTCE 和 TCDc 检测 RLS 的一致性。
TTCE 和 TCDc 均对潜在的 PAVM 具有 100%的敏感性；特异性分别为 25%和 38%。TTCE 和 TCD 在检测 RLS 方面的一致性很高（κ=0.76）。TCD 在接下来的 3 个月内耐受性良好，无立即的不良反应或栓塞事件。
TCDc 为 HHT 患者 PAVM 相关 RLS 的筛查提供了一种简单的基于办公室的 TTCE 替代方法。
