在盐水对比剂经胸超声心动图检测卵圆孔未闭时使用派对气球充气操作的影响：INFLATE-PFO注册研究
Impact of party balloon inflation manoeuvre during saline contrast transthoracic echocardiography for patent foramen ovale detection: INFLATE-PFO registry.
作者信息
Kataoka Akihisa, Izumo Masaki, Kito Kento, Katayama Taiga, Arakawa Masataka, Amano Masashi, Mochizuki Yasuhide, Iwano Hiroyuki, Nakaoka Yoko, Yamashita Eiji, Uno-Eder Kiyoko, Yamada Hirotsugu, Kozuma Ken
机构信息
Division of Cardiology, Department of Internal Medicine, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
出版信息
Eur Heart J Imaging Methods Pract. 2025 Jun 12;3(1):qyaf080. doi: 10.1093/ehjimp/qyaf080. eCollection 2025 Jan.
AIMS
Paradoxical embolism from a patent foramen ovale (PFO) can cause cryptogenic stroke. Agitated saline contrast transthoracic echocardiography (ASC-TTE), with the Valsalva manoeuvre (VM), is crucial for diagnosing PFO. However, the VM is associated with false-negative outcomes. The party balloon inflation manoeuvre (PBIM) provides improved visualisation of provocation; however, its real-world efficacy remains uncertain. This study aimed to demonstrate the superiority of the PBIM over standard provocative methods (conventional or abdominal compression VM) during ASC-TTE.
METHODS AND RESULTS
This multicentre retrospective observational registry study involved 117 consecutive patients (62.3% male; mean age, 56.2 ± 13.8 years) with PFO detected by transoesophageal echocardiography. During ASC-TTE, patients underwent PBIM and standard provocative methods. The primary endpoint was a five-point microbubble grading [representing a right-to-left (RL) shunt] change. Diagnostic performance of a significant RL shunt defined as Grade ≥2 in the five-point microbubble grading was assessed using McNemar's test. Compared with standard provocative methods using Wilcoxon paired analysis, the PBIM resulted in microbubble upgrading in 51 patients, no change in 54, and downgrading in 12. The PBIM had a significantly higher microbubble grade than standard provocative methods [median, 3.0; interquartile range (IQR), 3.0-4.0 vs. 3.0; IQR, 1.7-4.0; < 0.001]. For significant RL shunts, where transcatheter PFO closure would be clinically advised, PBIM improved diagnostic performance from 75.2% to 91.5% ( < 0.001).
CONCLUSION
PBIM indicated transcatheter PFO closure in patients with cryptogenic stroke and suspected PFOs, particularly those with false-negative diagnoses for shunts. PBIM demonstrates greater efficacy than standard provocative methods during ASC-TTE, providing clinical practicality.
CLINICAL TRIAL REGISTRATION
uMIN Clinical Trials Registry UMIN000051954 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000058907).
目的
卵圆孔未闭（PFO）导致的反常栓塞可引起不明原因的卒中。采用Valsalva动作（VM）的 agitated 盐水对比经胸超声心动图（ASC-TTE）对诊断PFO至关重要。然而，VM与假阴性结果相关。派对气球充气动作（PBIM）能更好地显示激发试验情况；但其在实际应用中的疗效仍不确定。本研究旨在证明在ASC-TTE期间PBIM优于标准激发方法（传统或腹部加压VM）。
方法与结果
这项多中心回顾性观察登记研究纳入了117例经食管超声心动图检测出PFO的连续患者（男性占62.3%；平均年龄56.2±13.8岁）。在ASC-TTE期间，患者接受了PBIM和标准激发方法。主要终点是五点微泡分级[代表右向左（RL）分流]的变化。使用McNemar检验评估五点微泡分级中定义为≥2级的显著RL分流的诊断性能。与使用Wilcoxon配对分析的标准激发方法相比，PBIM使51例患者微泡分级升高，54例无变化，12例降低。PBIM的微泡分级显著高于标准激发方法[中位数，3.0；四分位间距（IQR），3.0 - 4.0 vs. 3.0；IQR，1.7 - 4.0；<0.001]。对于临床建议行经导管PFO封堵的显著RL分流，PBIM将诊断性能从75.2%提高到91.5%（<0.001）。
结论
PBIM可用于不明原因卒中且疑似PFO患者的经导管PFO封堵，尤其是那些分流诊断为假阴性的患者。PBIM在ASC-TTE期间显示出比标准激发方法更高的疗效，具有临床实用性。
临床试验注册
uMIN临床试验注册中心UMIN000051954（https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000058907）
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