Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts -: Time window and threshold in microbubble numbers
Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts -: Time window and threshold in microbubble numbers
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DOI：
10.1161/01.str.31.7.1640
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发表时间：
2000-07-01
期刊：
影响因子：
8.3
通讯作者：
Ringelstein, EB
中科院分区：
文献类型：
--
作者：
Droste, DW;Silling, K;Ringelstein, EB
背景和目的-心脏右向左分流可以通过经食管确定。超声心动图（TEE）和经颅多普勒超声（TCD），使用造影剂和Varsalva动作（VM）作为激发程序。目前，VM的适当时机，使用的诊断时间窗口，和造影剂微泡检测的阈值的数据是不足的。方法58例进行了研究，TEE和双侧TCD的大脑中动脉。以随机方式应用以下方案，注射10 mt市售半乳糖基造影剂Echovist：（1）无VM，（2）在造影剂注射开始后2秒开始VM持续5秒，（3）在造影剂注射开始后5秒开始VM持续5秒，（4）造影剂注射开始后8秒开始的5秒VM，以及（5）造影剂注射开始后2 - 13秒之间的重复短VM。除了单一的测试，我们还测试了与VM的测试的组合结果的敏感性和特异性。结果，在21例患者中，右向左分流被证明由TEE和对比TCD（分流阳性）。21例患者两项检查均为阴性，无患者TEE检查阳性而TCD检查阴性，16例患者至少I次TCD检查阳性而TEE检查阴性。测试3是最合适的测试，当与VM的其他测试之一的结果相结合时。最高的灵敏度达到了40秒的诊断时间窗口，当一个单一的微泡的存在是足够的诊断shunt.Conclusions-TCD进行了两次2激发演习Echovist是一个敏感的方法，以确定TEE证明心脏右向左分流。VM应在造影剂注射开始后5秒开始执行5秒。
Background and Purpose-Cardiac right-to-left shunts can be identified by transesophageal. echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of contrast agents and a Varsalva maneuver (VM) as provocation procedure. Currently, data on the appropriate timing of the VM, the use of a diagnostic time window, and a threshold in contrast agent microbubbles detected are insufficient.Methods-Fifty-eight patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with injections of 10 mt of the commercial galactose-based contrast agent Echovist was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 2 seconds after the beginning of contrast injection, (3) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, (4) VM for 5 seconds starting 8 seconds after the beginning of contrast injection, and (5) repetitive short VMs in between 2 and 13 seconds after the beginning of contrast injection. In addition to the single tests, we also tested the sensitivity and specificity of combined results of the tests with VM.Results-In 21 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-one patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 16 patients were only positive on at least I TCD investigation but negative during TEE. Test 3 was the most appropriate test when combined with the results of 1 of the other tests with VM. The highest sensitivities were achieved with a diagnostic time window of 40 seconds and when the presence of a single microbubble was sufficient for the diagnosis of a shunt.Conclusions-TCD performed twice with 2 provocation maneuvers with Echovist is a sensitive method to identify TEE-proven cardiac right-to-left shunts. The VM should be performed for 5 seconds starting at 5 seconds after the beginning of contrast injection.