Department of Ultrasound, Haimen District People's Hospital, Nantong, China.
Department of Cardiology, Haimen District People's Hospital, Nantong, China.
Clin Cardiol. 2024 Aug;47(8):e24319. doi: 10.1002/clc.24319.
This study aims to evaluate the application value of contrast-enhanced transthoracic echocardiography (cTEE) in the diagnosis of patent foramen ovale (PFO) under different states of stimulation, with the goal of enhancing the accuracy and efficiency of PFO diagnosis.
This research consecutively enrolled patients suspected of having PFO from October 2022 to February 2024, presenting primary clinical symptoms such as unexplained syncope, headache, dizziness, and stroke. Patients underwent standard transthoracic echocardiography (TTE) and cTEE under three different states of stimulation (resting state, coughing, and Valsalva maneuver). Based on the presence of microbubbles in the left heart and their initial appearance time, patients were classified into PFO and control groups, with further diagnostic confirmation via transesophageal echocardiography (TEE) or foramen ovale closure procedures.
The study results revealed significant differences between the PFO and control groups regarding age (p = 0.034) and headache symptoms (p = 0.001). In the PFO group, TTE showed a higher positivity rate both at rest and during coughing, highlighting the association between PFO and specific clinical symptoms. The number of microbubbles observed during TTE increased significantly under various stimulation states, particularly during the Valsalva maneuver (p < 0.05). This increase became more pronounced as the duration of the maneuver was extended, underscoring the differential response of PFO patients under varied physiological testing conditions, especially during prolonged Valsalva maneuvers.
The study confirms the significant value of cTEE in diagnosing PFO under different stimulation states, particularly emphasizing the application of the Valsalva maneuver to significantly improve the sensitivity and specificity of PFO detection. Thus, incorporating cTEE examinations under various stimulation states holds significant clinical importance for enhancing the accuracy and efficiency of PFO diagnosis.
本研究旨在评估对比增强经胸超声心动图（cTEE）在不同刺激状态下诊断卵圆孔未闭（PFO）的应用价值，以提高 PFO 诊断的准确性和效率。
本研究连续纳入 2022 年 10 月至 2024 年 2 月期间因不明原因晕厥、头痛、头晕和中风等主要临床症状疑似 PFO 的患者。患者在三种不同刺激状态（静息状态、咳嗽和瓦尔萨尔瓦动作）下进行标准经胸超声心动图（TTE）和 cTEE。根据左心内微泡的存在及其初始出现时间，将患者分为 PFO 组和对照组，进一步通过经食管超声心动图（TEE）或卵圆孔关闭术进行诊断确认。
研究结果显示，PFO 组和对照组在年龄（p=0.034）和头痛症状（p=0.001）方面存在显著差异。在 PFO 组中，TTE 在静息和咳嗽时的阳性率均较高，提示 PFO 与特定临床症状之间存在关联。在各种刺激状态下，TTE 观察到的微泡数量显著增加，尤其是在瓦尔萨尔瓦动作时（p<0.05）。随着动作持续时间的延长，这种增加变得更加明显，突出了 PFO 患者在不同生理测试条件下的差异反应，尤其是在长时间的瓦尔萨尔瓦动作时。
本研究证实了 cTEE 在不同刺激状态下诊断 PFO 的重要价值，特别强调了瓦尔萨尔瓦动作的应用可以显著提高 PFO 检测的敏感性和特异性。因此，在各种刺激状态下进行 cTEE 检查对于提高 PFO 诊断的准确性和效率具有重要的临床意义。
