目的:本研究旨在评估经胸超声心动图(cTEE)在不同刺激状态下诊断卵圆孔未闭(PFO)的应用价值。目的是提高PFO诊断的准确性和效率。
方法:这项研究连续招募了2022年10月至2024年2月怀疑患有PFO的患者,这些患者出现了不明原因的晕厥等主要临床症状,头痛,头晕,和中风。患者在三种不同的刺激状态(静息状态,咳嗽,和瓦尔萨尔瓦机动)。根据左心微泡的存在及其初始出现时间,患者分为PFO组和对照组,通过经食管超声心动图(TEE)或卵圆孔闭合手术进一步诊断。
结果:研究结果显示PFO组和对照组在年龄(p=0.034)和头痛症状(p=0.001)方面存在显著差异。在PFO组中,TTE在休息和咳嗽时都表现出更高的阳性率,强调PFO和特定临床症状之间的关联。在各种刺激状态下,在TTE期间观察到的微泡数量显着增加,特别是在Valsalva动作期间(p<0.05)。随着机动持续时间的延长,这种增加变得更加明显,强调PFO患者在不同生理测试条件下的差异反应,尤其是在长时间的Valsalva演习中.
结论:该研究证实了cTEE在不同刺激状态下诊断PFO的重要价值,特别强调Valsalva动作的应用,以显著提高PFO检测的灵敏度和特异性。因此,在各种刺激状态下合并cTEE检查对于提高PFO诊断的准确性和效率具有重要的临床重要性。
OBJECTIVE: This study aims to evaluate the application value of contrast-enhanced transthoracic echocardiography (cTEE) in the diagnosis of patent foramen ovale (PFO) under different states of stimulation, with the goal of enhancing the accuracy and efficiency of PFO diagnosis.
METHODS: This research consecutively enrolled patients suspected of having PFO from October 2022 to February 2024, presenting primary clinical symptoms such as unexplained syncope, headache, dizziness, and stroke. Patients underwent standard transthoracic echocardiography (TTE) and cTEE under three different states of stimulation (resting state, coughing, and Valsalva maneuver). Based on the presence of microbubbles in the left heart and their initial appearance time, patients were classified into PFO and control groups, with further diagnostic confirmation via transesophageal echocardiography (TEE) or foramen ovale closure procedures.
RESULTS: The study results revealed significant differences between the PFO and control groups regarding age (p = 0.034) and headache symptoms (p = 0.001). In the PFO group, TTE showed a higher positivity rate both at rest and during coughing, highlighting the association between PFO and specific clinical symptoms. The number of microbubbles observed during TTE increased significantly under various stimulation states, particularly during the Valsalva maneuver (p < 0.05). This increase became more pronounced as the duration of the maneuver was extended, underscoring the differential response of PFO patients under varied physiological testing conditions, especially during prolonged Valsalva maneuvers.
CONCLUSIONS: The study confirms the significant value of cTEE in diagnosing PFO under different stimulation states, particularly emphasizing the application of the Valsalva maneuver to significantly improve the sensitivity and specificity of PFO detection. Thus, incorporating cTEE examinations under various stimulation states holds significant clinical importance for enhancing the accuracy and efficiency of PFO diagnosis.