Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Rd, Shanghai, 200040, China.
Department of Neurology and Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
BMC Neurol. 2022 Feb 4;22(1):43. doi: 10.1186/s12883-022-02565-w.
The aim of this study was to develop a screening score system of non-contrast transthoracic echocardiography (TTE) for patent foramen ovale (PFO) in patients with embolic stroke of undetermined source (ESUS).
We performed a retrospective analysis of 218 consecutive patients with a recent ESUS from 2015 to 2018, who received TTE and transcranial Doppler (TCD) as routine examinations. PFO was diagnosed by the bubble test of TCD. Significant differences of the non-contrast TTE findings and patient characteristics between PFO group and non-PFO group were selected into a score.
PFO was diagnosed in 35.8% (78/218) of the patients. Compared with non-PFO group, a larger median aortic root diameter (ARd) (34 mm vs. 32 mm, p = 0.005), a lower median peak E wave velocity (Em) (61.5 cm/s vs. 68 cm/s, p = 0.005) and a lower incidence rate of mitral regurgitation (34.6% vs. 50.7%, p = 0.022) were seen in PFO group. ARd>33 mm and Em < 72 cm/s were the best thresholds to predict PFO in ROC analysis. A four-point score system (MEAD) including TTE criteria (including ARd>33 mm, Em < 72 cm/s and without mitral regurgitation) and no history of diabetes predicted PFO with an area under curve of 0.67 (95%CI 0.57-0.72, p < 0.001). MEAD score ≥ 3 was the best threshold to predict PFO with an accuracy of 0.64 (95% CI 0.57-0.7), a sensitivity of 0.65 (95% CI 0.53-0.75) and a specificity of 0.63 (95% CI 0.55-0.71).
The MEAD score measured with non-contrast TTE can be used to select patients for bubble test of TCD to increase the diagnostic yield of PFO after ESUS.
本研究旨在为来源不明栓塞性卒中（ESUS）患者建立非增强经胸超声心动图（TTE）检测卵圆孔未闭（PFO）的筛查评分系统。
我们对 2015 年至 2018 年期间连续 218 例 ESUS 患者进行回顾性分析，这些患者接受了 TTE 和经颅多普勒（TCD）作为常规检查。PFO 通过 TCD 的微泡试验进行诊断。在 PFO 组和非 PFO 组之间选择非增强 TTE 发现和患者特征的显著差异进入评分。
在 218 例患者中，35.8%（78/218）诊断为 PFO。与非 PFO 组相比，PFO 组的主动脉根部直径中位数（ARd）更大（34mm 比 32mm，p=0.005），E 波峰值速度中位数（Em）更低（61.5cm/s 比 68cm/s，p=0.005），二尖瓣反流发生率更低（34.6%比 50.7%，p=0.022）。ROC 分析显示，ARd>33mm 和 Em<72cm/s 是预测 PFO 的最佳阈值。包括 TTE 标准（包括 ARd>33mm、Em<72cm/s 和无二尖瓣反流）和无糖尿病史的四项评分系统（MEAD）预测 PFO 的曲线下面积为 0.67（95%CI 0.57-0.72，p<0.001）。MEAD 评分≥3 是预测 PFO 的最佳阈值，其准确性为 0.64（95%CI 0.57-0.7），敏感性为 0.65（95%CI 0.53-0.75），特异性为 0.63（95%CI 0.55-0.71）。
使用非增强 TTE 测量的 MEAD 评分可用于选择 TCD 微泡试验患者，以提高 ESUS 后 PFO 的诊断率。
