微泡经颅多普勒超声联合经胸超声心动图造影对卵圆孔未闭伴隐源性脑卒中患者的诊断价值。

Diagnostic Value of Micro-Bubble Transcranial Doppler Combined with Contrast Transthoracic Echocardiography in Cryptogenic Stroke Patients with Patent Foramen Ovale.

机构信息

Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.

Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.

出版信息

Neurol India. 2022 Jul-Aug;70(4):1403-1406. doi: 10.4103/0028-3886.355122.

DOI:10.4103/0028-3886.355122

PMID:36076635

Abstract

BACKGROUND

In recent years, increasing attention has been paid to cryptogenic stroke (CS) caused by the patent foramen ovale (PFO).

OBJECTIVE

This study aims to evaluate the value of microbubble transcranial Doppler (MB-TCD) combined with contrast transthoracic echocardiography (cTTE) in the diagnosis of cryptogenic stroke patients with PFO.

MATERIALS AND METHOD

From January 2014 to January 2019, patients who suffered from CS were recruited and divided into the cTTE group and MB-TCD combined with cTTE group. All patients were further checked by transesophageal echocardiography (TEE).

RESULTS

A total of 130 patients accepted cTTE examination, and 109 patients accepted MB-TCD combined with cTTE. In the group, 52 of the 54 positive patients were finally confirmed by TEE with PFO, and 12 of the 76 negative patients were finally confirmed by TEE with PFO. In combined group, 50 patients were negative on both two examination (Negative group), 54 were positive on both two examination (Positive group) and finally confirmed by TEE indeed with patent foramen ovale (PFO), while remaining five (5) patients were positive only on MB-TCD (Suspected group). After checked by TEE, three (3) of five patients with MB-TCD positive were confirmed by TEE indeed with PFO. The sensitivity, specificity, positive likelihood ratio (+LR), and Youden's index of cTEE in diagnostic of cryptogenic stroke patients with PFO were 81.25%, 96.97%, 26.82 and 0.78, respectively, and these for MB-TCD combined with cTTE were 100%, 96.15%, 25.97 and 0.96, respectively. MB-TCD medium can sensitively discover PFO in cryptogenic stroke patients with 100% sensitivity and a missdiagnosis rate of 0.

CONCLUSION

The combination of MB-TCD and cTTE can improve the sensitivity and specificity of PFO diagnosis in cryptogenic stroke patients. MB-TCD medium also had high sensitivity and specificity.

摘要

背景

近年来，人们越来越关注由卵圆孔未闭（PFO）引起的隐源性卒中（CS）。

目的

本研究旨在评估微泡经颅多普勒超声（MB-TCD）联合对比经胸超声心动图（cTTE）在诊断隐源性卒中合并 PFO 患者中的价值。

材料与方法

从 2014 年 1 月至 2019 年 1 月，我们招募了患有 CS 的患者，并将其分为 cTTE 组和 MB-TCD 联合 cTTE 组。所有患者均进一步接受经食管超声心动图（TEE）检查。

结果

共有 130 例患者接受了 cTTE 检查，109 例患者接受了 MB-TCD 联合 cTTE 检查。在该组中，54 例 MB-TCD 阳性患者中有 52 例最终通过 TEE 证实存在 PFO，76 例 MB-TCD 阴性患者中有 12 例最终通过 TEE 证实存在 PFO。在联合组中，50 例患者两项检查均为阴性（阴性组），54 例患者两项检查均为阳性（阳性组），最终通过 TEE 证实存在 PFO，而其余 5 例患者仅在 MB-TCD 检查中阳性（疑似组）。通过 TEE 检查，5 例 MB-TCD 阳性患者中有 3 例最终通过 TEE 证实存在 PFO。cTTE 诊断隐源性卒中合并 PFO 的敏感性、特异性、阳性似然比（+LR）和 Youden 指数分别为 81.25%、96.97%、26.82%和 0.78%，而 MB-TCD 联合 cTTE 的敏感性、特异性、阳性似然比和 Youden 指数分别为 100%、96.15%、25.97%和 0.96%。MB-TCD 中等可以灵敏地发现隐源性卒中患者的 PFO，其敏感性为 100%，误诊率为 0。