可见视网膜栓子用于检测需要抗凝治疗或心脏手术的心脏栓塞性病变的准确性。心脏源性视网膜栓子研究组。

Accuracy of visible retinal emboli for the detection of cardioembolic lesions requiring anticoagulation or cardiac surgery. Retinal Emboli of Cardiac Origin Study Group.

作者信息

Sharma S, Brown G C, Cruess A F

机构信息

Coordinating Centre, Queen's University, Kingston Ontario, Canada.

出版信息

Br J Ophthalmol. 1998 Jun;82(6):655-8. doi: 10.1136/bjo.82.6.655.

DOI:10.1136/bjo.82.6.655

PMID:9797667

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1722615/

Abstract

AIM

To determine the accuracy of visible retinal emboli as a diagnostic "test" for the likelihood of receiving anticoagulation or cardiac surgery based on the results of transthoracic echocardiography, in the setting of acute retinal arterial occlusion.

METHODS

A multicentre retrospective diagnostic study at Kingston Eye Centre, Queen's University, Kingston, Ontario; Wills Eye Hospital, Philadelphia; Ottawa Eye Institute, Ottawa, Ontario; and the Halifax Infirmary, Halifax, Nova Scotia of 104 patients with both embolic and nonembolic acute retinal arterial obstruction who underwent transthoracic echocardiography was performed, to determine the accuracy of visible retinal emboli as a diagnostic "test" for anticoagulation or cardiac surgery. Anticoagulation or surgical intervention on the basis of abnormalities was detected solely through the technology of transthoracic echocardiography.

RESULTS

41 patients had visible retinal emboli (calcific, cholesterol, or fibrin). The remaining 63 had no evidence of embolic disease. The sensitivity of emboli for the likelihood of a patient receiving anticoagulation or cardiac surgery was 50%. The specificity, positive predictive value, and negative predictive value were 62%, 15%, and 90%, respectively. The likelihood ratio (LR = 1.31) obtained given the presence of a visible retinal embolus was neither clinically nor statistically significant (LR+ve = 1.31; 95% CI (0.91, 3.16)). This likelihood ratio, when applied to a patient with a pretest probability of 50%, results in a post-test probability of 56.7%.

CONCLUSIONS

These results demonstrate that the presence of a visible retinal embolus should not be the sole determinant of whether to order transthoracic echocardiography, as the likelihood ratio for a patient receiving anticoagulation or cardiac surgery, given the presence of a visible retinal embolus was only 1.31.

摘要

目的

在急性视网膜动脉阻塞的情况下，根据经胸超声心动图的结果，确定可见性视网膜栓子作为一种诊断“测试”，用于预测接受抗凝治疗或心脏手术可能性的准确性。

方法

在安大略省金斯顿女王大学金斯顿眼科中心、费城威尔斯眼科医院、安大略省渥太华渥太华眼科研究所和新斯科舍省哈利法克斯哈利法克斯医院进行了一项多中心回顾性诊断研究，纳入104例患有栓塞性和非栓塞性急性视网膜动脉阻塞且接受了经胸超声心动图检查的患者，以确定可见性视网膜栓子作为抗凝治疗或心脏手术诊断“测试”的准确性。基于异常情况的抗凝治疗或手术干预仅通过经胸超声心动图技术检测。

结果

41例患者有可见性视网膜栓子（钙化、胆固醇或纤维蛋白栓子）。其余63例没有栓塞性疾病的证据。栓子对于患者接受抗凝治疗或心脏手术可能性的敏感性为50%。特异性、阳性预测值和阴性预测值分别为62%、15%和90%。出现可见性视网膜栓子时获得的似然比（LR = 1.31）在临床和统计学上均无显著意义（LR+ve = 1.31；95%置信区间(0.91, 3.16)）。当将此似然比应用于预测试概率为50%的患者时，得出的测试后概率为56.7%。