Importance of Abdominal Compression Valsalva Maneuver and Microbubble Grading in Contrast Transthoracic Echocardiography for Detecting Patent Foramen Ovale
Importance of Abdominal Compression Valsalva Maneuver and Microbubble Grading in Contrast Transthoracic Echocardiography for Detecting Patent Foramen Ovale
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DOI：
10.1016/j.echo.2019.09.018
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发表时间：
2020-02-01
影响因子：
6.5
通讯作者：
Ito, Hiroshi
中科院分区：
文献类型：
--
作者：
Takaya, Yoichi;Watanabe, Nobuhisa;Ito, Hiroshi
背景：尽管经胸超声心动图(TTE)可用于卵圆孔未闭(PFO)的筛查，但最佳方法尚不清楚。目的：以经食道超声心动图和导管术为对照，评价腹压Valsalva法的疗效，确定经食道超声心动图和导管术检测PFO的最佳微泡截断值。方法：134例拟诊为PFO的隐源性卒中或偏头痛患者，行经食道超声心动图和导管术。根据不同的刺激方式(自发Valsalva动作、腹压Valsalva动作)和不同的微泡截断值(至少1个微泡，至少5个微泡)，分析TTE检测PFO的敏感性、特异性和准确性。结果：80例患者经食道超声心动图和导管术证实存在PFO。当截断点至少为一个微泡时，TTE检测PFO的敏感性，自发Valsalva动作为93%，腹压Valsalva动作为99%。当阈值至少为5个微泡时，自发Valsalva动作的敏感性为85%，腹压Valsalva动作的敏感性为99%。采用腹部加压Valsalva手法，与至少切断一个微泡相比，截断至少五个微泡的特异性增加(89%比57%)。切断至少5个微泡的腹压Valsalva法准确率最高，达95%。结论：TTE与腹压Valsalva法联合应用具有良好的敏感性。至少五个微泡的截止值增加了特异性。我们的发现表明，符合这些标准的TTE对PFO的诊断是有价值的。
Background: Although transthoracic echocardiography (TTE) may be useful for patent foramen ovale (PFO) screening, the optimal methodologies remain unclear. The aims of this study were to evaluate the efficacy of the abdominal compression Valsalva maneuver and identify the optimal cutoff value of microbubbles in contrast TTE for detecting PFO, compared with transesophageal echocardiography and catheterization as the reference.Methods: One hundred thirty-four patients with cryptogenic stroke or migraine who had suspected PFO and underwent TTE and transesophageal echocardiography plus catheterization were enrolled. The sensitivity, specificity, and accuracy of TTE for PFO detection were analyzed according to different provocations (spontaneous Valsalva maneuver, abdominal compression Valsalva maneuver) and different cutoff values of microbubbles for a positive result (at least one microbubble, at least five microbubbles).Results: Eighty patients had PFO confirmed by transesophageal echocardiography and catheterization. When the cutoff was at least one microbubble, the sensitivity of TTE in detecting PFO was 93% with the spontaneous Valsalva maneuver and 99% with the abdominal compression Valsalva maneuver. When the cutoff was at least five microbubbles, sensitivity was 85% with the spontaneous Valsalva maneuver and 99% with the abdominal compression Valsalva maneuver. With the abdominal compression Valsalva maneuver, specificity was increased using the cutoff of at least five microbubbles compared with at least one microbubble (89% vs 57%). The abdominal compression Valsalva maneuver with the cutoff of at least 5 microbubbles provided the greatest accuracy of 95%.Conclusions: TTE with the abdominal compression Valsalva maneuver had excellent sensitivity. The cutoff of at least five microbubbles increased specificity. Our findings suggest that TTE with these criteria is valuable for PFO diagnosis.