Sensitivity of Transcranial Doppler Versus Intracardiac Echocardiography in the Detection of Right-to-Left Shunt
Sensitivity of Transcranial Doppler Versus Intracardiac Echocardiography in the Detection of Right-to-Left Shunt
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DOI：
10.1016/j.jcmg.2009.12.012
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发表时间：
2010-04-01
影响因子：
14
通讯作者：
Tobis, Jonathan
中科院分区：
文献类型：
--
作者：
Van, HoHai;Poommipanit, Paul;Tobis, Jonathan
本研究的目的是了解不同方法检测右向左分流（RLS）的灵敏度变化的原因。背景卵圆孔未闭（PFO）与隐源性中风、减压病和偏头痛的发病机制有关。静脉内搅动盐水注射与断层成像（经胸、经食管和心内超声心动图）已用于检测心内分流。一些临床高度怀疑PFO的患者的超声心动图研究结果不确定。经颅多普勒（TCD）是一种替代方法检测RLS，不依赖于断层imaging.METHODS 38例连续患者谁正在接受PFO关闭同时进行经颅多普勒和心内超声心动图。在静息状态下进行搅拌盐水注射，采用Valsalva动作，并在闭合前后以及闭合后3个月或更长时间内用力呼气进入压力计至40 mm Hg。在围手术期测量右心房压力，并根据标准方法对这些动作进行RLS分级。结果Valsalva动作时右心房压力明显高于静息时（闭合前21.6 +/- 11.9 mm Hg vs. 6.6 +/- 2.6 mm Hg，p < 0.001;闭合后28.4 +/- 13.9 mm Hg vs. 6.8 +/- 2.6 mm Hg，p < 0.001），并与Valsalva动作相比（闭合前38.7 +/- 6.6 mm Hg对比21.6 +/- 11.9 mm Hg，p < 0.001;闭合后44.0 +/- 9.5 mm Hg对比28.4 +/- 13.9 mm Hg，p < 0.001）。心内超声心动图低估了分流在34%的患者Valsalva动作或测压器关闭后相比，TCD.CONCLUSIONS经颅多普勒与即时反馈提供的强制呼气对测压器到40毫米汞柱是更敏感的比超声心动图成像检测RLS。这些观察结果对确定卒中或偏头痛患者的RLS发生率具有重要意义。（美国科尔心脏病学杂志2010;3：343-8）（C）美国心脏病学会基金会2010年
OBJECTIVES The purpose of this study was to understand the reason for variation in the sensitivity of different methods of detecting right-to-left shunts (RLS).BACKGROUND Patent foramen ovale (PFO) is implicated in the pathogenesis of cryptogenic stroke, decompression illness, and migraine headaches. Intravenous agitated saline injections with tomographic imaging (transthoracic, transesophageal, and intracardiac echocardiography) has been used for detecting intracardiac shunts. Some patients with a high clinical suspicion of PFO have inconclusive echocardiographic study results. Transcranial Doppler (TCD) is an alternative method for detecting RLS that is not dependent on tomographic imaging.METHODS Thirty-eight consecutive patients who were undergoing PFO closure had simultaneous transcranial Doppler and intracardiac echocardiography performed. Agitated saline injections were performed at rest, with Valsalva maneuver, and with forced expiration into a manometer to 40 mm Hg before and after closure, as well as 3 or more months after closure. Right atrial pressures were measured in the periprocedural period, and RLS were graded according to standard methods during these maneuvers.RESULTS Right atrial pressures were significantly higher with Valsalva maneuver compared with rest (before closure 21.6 +/- 11.9 mm Hg vs. 6.6 +/- 2.6 mm Hg, p < 0.001; after closure 28.4 +/- 13.9 mm Hg vs. 6.8 +/- 2.6 mm Hg, p < 0.001) and with manometer compared with Valsalva maneuver (before closure 38.7 +/- 6.6 mm Hg vs. 21.6 +/- 11.9 mm Hg, p < 0.001; after closure 44.0 +/- 9.5 mm Hg vs. 28.4 +/- 13.9 mm Hg, p < 0.001). Intracardiac echocardiography underestimated shunting in 34% of patients with Valsalva maneuver or manometer after closure compared with TCD.CONCLUSIONS Transcranial Doppler with immediate feedback provided by forced expiration against a manometer to 40 mm Hg is more sensitive than echocardiographic imaging for the detection of RLS. These observations have significant implications for determining the incidence of RLS in patients with stroke or migraine. (J Am Coll Cardiol Img 2010;3:343-8) (C) 2010 by the American College of Cardiology Foundation