Huang Wei, Wang Hebo
Department of Neurology, Hebei Medical University, Shijiazhuang, China.
Department of Neurology, Baoding No.1 Central Hospital, Baoding, China.
Perfusion. 2023 Sep 1:2676591231198356. doi: 10.1177/02676591231198356.
In this study, we aimed to assess the predictive value of transesophageal echocardiography (TEE) combined with contrast transthoracic echocardiography (cTTE) for embolic stroke of undetermined source (ESUS).
A total of 52 patients with ESUS were examined by TEE and cTTE. The detection rate of patent foramen ovale (PFO) and right-to-left shunt (RLS) grade were compared in patients with ESUS between cTTE alone and cTTE combined with TEE. The Risk of Paradoxical Embolism (RoPE) score, PFO diameter, and PFO length of patients with PFO-associated ESUS and non-PFO-associated ESUS were compared by cTTE alone and cTTE combined with TEE. The receiver operating characteristic (ROC) curve was utilized to determine the effect of RoPE score and PFO diameter on patients with PFO-associated ESUS.
The positive rate of PFO detected by cTTE alone (46.15%) was lower than that detected by cTTE combined with TEE (69.23%). The proportion of patients with RLS grade I + II + III detected by cTTE combined with TEE (69.23%) was higher than that detected by cTTE alone (46.15%). Both the RoPE score and PFO diameter were significantly greater in the patients with PFO-associated ESUS than in the patients with non-PFO-associated ESUS ( < .05). The combination of RoPE score and PFO diameter had the largest area under the ROC curve (AUC = 0.875), which was larger than the AUC alone of RoPE score (AUC = 0.819) and PFO diameter (AUC = 0.783) ( < .05).
The combination of cTTE and TEE is helpful to the diagnosis of ESUS patients caused by PFO and to judge the degree of RLS.
在本研究中，我们旨在评估经食管超声心动图（TEE）联合对比剂经胸超声心动图（cTTE）对不明来源栓塞性卒中（ESUS）的预测价值。
共对52例ESUS患者进行了TEE和cTTE检查。比较了单纯cTTE与cTTE联合TEE检查的ESUS患者中卵圆孔未闭（PFO）的检出率及右向左分流（RLS）分级。通过单纯cTTE与cTTE联合TEE比较了PFO相关ESUS和非PFO相关ESUS患者的反常栓塞风险（RoPE）评分、PFO直径和PFO长度。利用受试者工作特征（ROC）曲线确定RoPE评分和PFO直径对PFO相关ESUS患者的影响。
单纯cTTE检测PFO的阳性率（46.15%）低于cTTE联合TEE检测的阳性率（69.23%）。cTTE联合TEE检测出的RLS I + II + III级患者比例（69.23%）高于单纯cTTE检测出的比例（46.15%）。PFO相关ESUS患者的RoPE评分和PFO直径均显著高于非PFO相关ESUS患者（P <.05）。RoPE评分与PFO直径联合时ROC曲线下面积最大（AUC = 0.875），大于单独RoPE评分（AUC = 0.819）和PFO直径（AUC = 0.783）的AUC（P <.05）。
cTTE与TEE联合有助于诊断由PFO引起的ESUS患者并判断RLS程度。
