Department of Ultrasound Diagnostics, The Second Hospital of Yulin City, Yulin, China.
Department of Ultrasound Diagnostics, The First Affiliated Hospital, Xi'an Medical College, Xi'an, China.
Scand Cardiovasc J. 2020 Feb;54(1):32-36. doi: 10.1080/14017431.2019.1694172. Epub 2019 Nov 28.
: The purpose of this study was to explore the different provocative maneuvers in detecting right-to-left shunt during contrast transthoracic echocardiography (cTTE). : We evaluated 378 patients for right-to-left shunt detection by cTTE at the quiet respiration, during Valsalva maneuver (blowing into a face mask connected to a sphygmomanometer at 40 mmHg for 10 s), and during cough maneuver, performed in random order, and the degree of right-to-left shunt as the number of microbubbles in the left atrium per frame after each provocative maneuver was recorded. : The detection rates of right-to-left shunt for quiet respiration, Valsalva maneuver, and cough maneuver were 16%, 33%, and 38%, respectively ( < .001). The detection rate for cough maneuver was significantly higher than that for Valsalva maneuver ( < .001). There was no significant difference between Valsalva maneuver and cough maneuver in terms of detecting moderate- or severe-extent right-to-left shunt ( > .05), but cough maneuver was significantly better than Valsalva maneuver at detecting mild-extent right-to-left shunt ( = .001). : Cough maneuver is an effective alternative to Valsalva maneuver, with a higher detection rate for mild-extent right-to-left shunt during cTTE, maybe due to its own mechanical characteristics.
: 本研究旨在探讨对比经胸超声心动图（cTTE）中检测右向左分流时不同激发手法的作用。 : 我们对 378 例患者在平静呼吸、瓦尔萨尔瓦动作（通过与血压计相连的面罩向 40mmHg 吹气 10 秒）和咳嗽动作时进行 cTTE 以检测右向左分流，并以每个激发动作后左心房每帧出现微泡的数量记录右向左分流的程度。 : 平静呼吸、瓦尔萨尔瓦动作和咳嗽动作检测右向左分流的检出率分别为 16%、33%和 38%（ < .001）。咳嗽动作的检出率明显高于瓦尔萨尔瓦动作（ < .001）。在检测中至重度右向左分流方面，瓦尔萨尔瓦动作和咳嗽动作之间没有显著差异（ > .05），但咳嗽动作在检测轻度右向左分流方面明显优于瓦尔萨尔瓦动作（ = .001）。 : 咳嗽动作是瓦尔萨尔瓦动作的有效替代方法，在 cTTE 中检测轻度右向左分流时检出率更高，可能与其自身的机械特性有关。
