Wang Yun-Ruo, Wu You, Xu Du-Juan, Liu Ru, Niu Su, Wu Hao
Department of Nephrology, Xuzhou Central Hospital, Xuzhou, 221009, China.
School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
BMC Nephrol. 2025 Jul 9;26(1):371. doi: 10.1186/s12882-025-04312-y.
To explore the value of transesophageal echocardiography(TEE) in the assessment of complications associated with hemodialysis tunneled cuffed catheters (TCC) in the superior vena cava (SVC).
A retrospective analysis was conducted on patients who underwent haemodialysis with TCC in SVC and developed catheter-related complications from 1 March 2020 to 31 July 2024 at Xuzhou Central Hospital. TEE and digital subtraction angiography (DSA) were performed on these patients at the same time. With DSA as a gold standard, sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TEE results were analyzed. Receiver operating characteristic(ROC) curve and area under ROC curve(AUC) were employed for examining the accuracy of TEE and verifying the consistency of two inspection results.
A total of 86 patients were included in the study, with a mean duration of TCC retention of 65.46 ± 24.58 months, and a site of TCC retention in the right internal jugular vein in 81 cases (94.19%) and in the left internal jugular vein in 5 case (5.81%).In the cohort of 86 patients, 57 (66.28%) exhibited positive findings on TEE examination. DSA was positive in 52 patients, representing a proportion of 60.47%. A total of 47 patients exhibited positive results on both the TEE and DSA examinations, while 24 patients demonstrated negative results in both tests. TEE has a sensitivity of 90.38%, a specificity of 70.59%, a positive predictive value of 82.46%, a negative predictive value of 82.76%, and a false positive rate of 29.41% in comparison to DSA. The false negative rate was 9.62%, the diagnostic accuracy was 82.56%, and the Youden index was 0.61. The Kappa value was 0.626, with P < 0.0001, indicating consistency between the TEE and DSA examination results. The area under the ROC curve was 0.805 [95% CI: 0.702-0.908], with P < 0.0001, indicating consistency between TEE and DSA examination results.
TEE is an invaluable tool for the assessment of complications associated with TCC in SVC. The non-invasive, cost-effective and convenient nature renders it an advantageous method for guiding treatment.
探讨经食管超声心动图（TEE）在评估上腔静脉（SVC）内带隧道带涤纶套血液透析导管（TCC）相关并发症中的价值。
对2020年3月1日至2024年7月31日在徐州中心医院接受SVC内TCC血液透析且发生导管相关并发症的患者进行回顾性分析。对这些患者同时进行TEE和数字减影血管造影（DSA）检查。以DSA作为金标准，分析TEE结果的敏感性、特异性、准确性、阳性预测值和阴性预测值。采用受试者工作特征（ROC）曲线及ROC曲线下面积（AUC）来检验TEE的准确性并验证两种检查结果的一致性。
本研究共纳入86例患者，TCC留置的平均时长为65.46±24.58个月，其中81例（94.19%）TCC留置部位在右颈内静脉，5例（5.81%）在左颈内静脉。在这86例患者队列中，57例（66.28%）TEE检查结果为阳性。DSA检查阳性的有52例，占比60.47%。共有47例患者TEE和DSA检查结果均为阳性，24例患者两项检查结果均为阴性。与DSA相比，TEE的敏感性为90.38%，特异性为70.59%，阳性预测值为82.46%，阴性预测值为82.76%，假阳性率为29.41%。假阴性率为9.62%，诊断准确性为82.56%，约登指数为0.61。Kappa值为0.626，P<0.0001，表明TEE和DSA检查结果具有一致性。ROC曲线下面积为0.805[95%CI：0.702 - 0.908]，P<0.0001，表明TEE和DSA检查结果具有一致性。
TEE是评估SVC内TCC相关并发症的重要工具。其无创、经济高效且便捷的特性使其成为指导治疗的优势方法。
