Philippe F, Florens E, Drobinski G, Isnard R, Thomas D
Service de cardiologie, Groupe hospitalier Pitié-Salpêtrière, Paris.
Arch Mal Coeur Vaiss. 1997 Sep;90(9):1247-53.
The authors undertook a prospective and comparative echocardiographic study of 2.5, 3.5 and 5 MHz ultrasonic transducers for the detection of left ventricular mural thrombosis in 53 patients with left ventricular dysfunction. Thirty-three patients had advanced ischaemic heart disease following anterior myocardial infarction and 20 had dilated cardiomyopathy with a left ventricular ejection fraction of < or = 40%. Eighty-two per cent of patients had anticoagulant therapy. The diagnosis of thrombosis was based on Asinger's classification. Eleven thrombi were detected, an incidence of 21%. Using the 5 MHz transducer as a reference, the sensitivity of the 3.5 MHz transducer was 100% and much greater than that of the 2.5 MHz transducer (55%) which was associated with 4 false positive results. The specificities were respectively 97 and 86% for the 3.5 and 2.5 MHz transducers. There was no correlation between the apical Doppler flow velocities and the presence of mural thrombosis. Atrial fibrillation was significantly associated with mural thrombosis (p = 0.04). The increased sensitivity associated with transducers of higher frequency is, however, limited by the echogenicity of patients. The introduction of transducers of variable frequencies should facilitate the diagnosis and improve the sensitivity of echocardiography in detecting left ventricular mural thrombosis.
作者对53例左心室功能不全患者进行了一项前瞻性比较超声心动图研究，以评估2.5兆赫、3.5兆赫和5兆赫超声换能器检测左心室壁血栓的效果。33例患者患有前壁心肌梗死后的晚期缺血性心脏病，20例患有扩张型心肌病，左心室射血分数≤40%。82%的患者接受了抗凝治疗。血栓形成的诊断基于阿辛格分类法。共检测到11个血栓，发生率为21%。以5兆赫换能器作为参照，3.5兆赫换能器的敏感性为100%，远高于2.5兆赫换能器（55%），后者出现了4例假阳性结果。3.5兆赫和2.5兆赫换能器的特异性分别为97%和86%。心尖部多普勒流速与壁血栓形成之间无相关性。房颤与壁血栓形成显著相关（p = 0.04）。然而，较高频率换能器相关的敏感性增加受到患者回声性的限制。可变频率换能器的引入应有助于诊断并提高超声心动图检测左心室壁血栓的敏感性。
