Lim Kyung Hee, Kim Sung Mok, Park Sung-Ji, Kim Eun Kyoung, Chang Sung-A, Lee Sang-Chol, Park Seung Woo, Choe Yeon Hyeon
Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Busan, South Korea.
Department of Radiology, Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Cardiovasc Med. 2022 Sep 8;9:975901. doi: 10.3389/fcvm.2022.975901. eCollection 2022.
This study evaluated the diagnostic value of transesophageal contrast echocardiography (TECE) with the agitated saline test for diagnosing pulmonary arteriovenous malformations (PAVMs) in comparison with chest CT or pulmonary angiography.
Although transthoracic contrast echocardiography (TTCE) is the recommended screening test for diagnosing PAVMs, it has low specificity and positive predictive value. TECE is expected to offer improved sensitivity and specificity compared with TTCE, but no studies have reported the diagnostic accuracy and clinical significance of TECE in detecting PAVMs.
In total, 1,809 patients underwent TECE with the agitated saline test to evaluate symptoms of a suspected right to left shunt. Patients with hereditary hemorrhagic telangiectasia (HHT) were excluded. A total of 387 patients showed transpulmonary bubble passage, indicating a PAVM. Among them, 182 patients had additional chest CT or pulmonary angiography. Those patients were divided into two groups according to the presence of a PAVM in the radiologic imaging. A total of 18 patients (9.8%) were confirmed for the PAVM group. Only 13 patients required embolization for their PAVMs. The TECE with saline test results were divided into four grades according to the number of bubbles: grade 1 ( = 91), grade 2 ( = 47), grade 3 ( = 35), and grade 4 ( = 9). None of the patients in the PAVM group had grade 1 shunts in their TECE results. The positive predictive values for the presence of a PAVM according to the TECE grade scale were 10.6% for grade 2, 22.8% for grade 3, and 55.6% for grade 4.
TECE with a grade scale is a useful method for initially diagnosing PAVMs in non-HHT patients with a suspected right to left shunt. The findings of this study also suggest that patients with a small grade (<10 bubbles) shunt in their TECE findings should be spared unnecessary radiation exposure from CT scans or pulmonary angiography.
本研究评估经食管对比超声心动图（TECE）联合生理盐水激发试验在诊断肺动静脉畸形（PAVM）方面的诊断价值，并与胸部CT或肺血管造影进行比较。
虽然经胸对比超声心动图（TTCE）是诊断PAVM的推荐筛查方法，但其特异性和阳性预测值较低。与TTCE相比，TECE有望提供更高的敏感性和特异性，但尚无研究报道TECE在检测PAVM方面的诊断准确性和临床意义。
共有1809例患者接受了TECE联合生理盐水激发试验，以评估疑似右向左分流的症状。排除患有遗传性出血性毛细血管扩张症（HHT）的患者。共有387例患者出现经肺气泡通过，提示存在PAVM。其中，182例患者还进行了胸部CT或肺血管造影。根据影像学检查中PAVM的存在情况，将这些患者分为两组。PAVM组共有18例患者（9.8%）得到确诊。只有13例患者的PAVM需要进行栓塞治疗。根据气泡数量，TECE联合生理盐水试验结果分为四个等级：1级（=91）、2级（=47）、3级（=35）和4级（=9）。PAVM组患者的TECE结果中均无1级分流。根据TECE分级标准，2级、3级和4级PAVM存在的阳性预测值分别为10.6%、22.8%和55.6%。
分级的TECE是初步诊断疑似右向左分流的非HHT患者PAVM的有用方法。本研究结果还表明，TECE检查结果为小分级（<10个气泡）分流的患者应避免因CT扫描或肺血管造影而受到不必要的辐射暴露。
