PDF(Pubmed)
Abstract：
BACKGROUND: Contrast-enhanced transcranial Doppler (cTCD) study has been established as one of the most common investigations for detecting right-to-left shunt (RLS). Although the conventional Valsalva maneuver (c-VM) has been used to increase the sensitivity of cTCD for RLS, efforts are still needed to improve the detection rate further. We proposed a new provocation method with a syringe-modified Valsalva maneuver (sm-VM) during cTCD and compared the efficacy of this strategy with cTCD measured at resting and with the provocation of c-VM.
METHODS: Consecutive patients with suspicion of RLS who underwent cTCD in our institution between September 27, 2021, and April 1, 2022, were included in this study. Examination of cTCD was performed separately at the resting state and provoked with c-VM and sm-VM. The overall proportion of patients with RLS and their distribution with different RLS grades were compared.
RESULTS: A total of 389 patients (mean age: 49.37 years, male: 52.2%) were included in this study. The positive rate for RLS was significantly higher for cTCD detected with sm-VM than those detected at resting state and with c-VM (46.8% vs. 21.6% and 34.2%, all p < .05). Besides, cTCD detected with sm-VM was also associated with a higher proportion of patients with grade III RLS than those detected at resting state and with c-VM (11.3% vs. 1.8% and 0%, all p < .05).
CONCLUSIONS: Compared to cTCD detected at resting state and with c-VM, cTCD with sm-VM could further increase the positive detection rate of RLS.
METHODS: Consecutive patients with suspicion of RLS who underwent cTCD in our institution between September 27, 2021, and April 1, 2022, were included in this study. Examination of cTCD was performed separately at the resting state and provoked with c-VM and sm-VM. The overall proportion of patients with RLS and their distribution with different RLS grades were compared.
RESULTS: A total of 389 patients (mean age: 49.37 years, male: 52.2%) were included in this study. The positive rate for RLS was significantly higher for cTCD detected with sm-VM than those detected at resting state and with c-VM (46.8% vs. 21.6% and 34.2%, all p < .05). Besides, cTCD detected with sm-VM was also associated with a higher proportion of patients with grade III RLS than those detected at resting state and with c-VM (11.3% vs. 1.8% and 0%, all p < .05).
CONCLUSIONS: Compared to cTCD detected at resting state and with c-VM, cTCD with sm-VM could further increase the positive detection rate of RLS.
摘要：
背景：对比增强经颅多普勒（cTCD）研究已被确定为检测右向左分流（RLS）的最常见研究之一。尽管传统的Valsalva机动（c-VM）已被用来提高cTCD对RLS的灵敏度，仍需努力提高检出率。我们提出了一种在cTCD期间使用注射器改良的Valsalva动作（sm-VM）的新激发方法，并将该策略的功效与静息时测得的cTCD和c-VM的激发进行了比较。
方法：本研究包括2021年9月27日至2022年4月1日在我们机构接受cTCD的连续怀疑RLS的患者。cTCD的检查在静息状态下分别进行，并用c-VM和sm-VM激发。比较RLS患者的总体比例及其在不同RLS分级下的分布。
结果：共有389名患者（平均年龄：49.37岁，男性：52.2%）纳入本研究。sm-VM检测到的cTCD的RLS阳性率明显高于静息状态和c-VM检测到的RLS阳性率（46.8％vs.21.6%和34.2%，所有p<.05）。此外,使用sm-VM检测到的cTCD也与III级RLS患者的比例高于在静息状态和c-VM检测到的患者（11.3％vs.1.8%和0%，所有p<.05）。
结论：与静息状态和c-VM检测到的cTCD相比，带有sm-VM的cTCD可以进一步提高RLS的阳性检出率。
方法：本研究包括2021年9月27日至2022年4月1日在我们机构接受cTCD的连续怀疑RLS的患者。cTCD的检查在静息状态下分别进行，并用c-VM和sm-VM激发。比较RLS患者的总体比例及其在不同RLS分级下的分布。
结果：共有389名患者（平均年龄：49.37岁，男性：52.2%）纳入本研究。sm-VM检测到的cTCD的RLS阳性率明显高于静息状态和c-VM检测到的RLS阳性率（46.8％vs.21.6%和34.2%，所有p<.05）。此外,使用sm-VM检测到的cTCD也与III级RLS患者的比例高于在静息状态和c-VM检测到的患者（11.3％vs.1.8%和0%，所有p<.05）。
结论：与静息状态和c-VM检测到的cTCD相比，带有sm-VM的cTCD可以进一步提高RLS的阳性检出率。
