摘要
Abstract
Objective To evaluate the diagnostic value of optimized contrast transcranial Doppler(cTCD)combined with contrast transthoracic echocardiography(cTTE)in synchronous detection of right-to-left shunt(RLS),optimize the procedural timing,and quantify the timing control between the Valsalva maneuver(VM)and intravenous injection of agitated saline.
Methods A retrospective analysis was conducted on patients who underwent RLS screening at the Second Xiangya Hospital of Central South University from September 2023 to September 2024 due to dizziness,headache,syncope,or cryptogenic stroke.Patients were divided into three groups according to the examination strategy:the optimized synchronous group(underwent optimized cTCD combined with cTTE synchronous detection),the optimized cTCD group(underwent optimized cTCD alone),and the non-optimized cTCD group(underwent conventional cTCD alone).The positive rate and grading distribution of RLS were compared among the groups.In the optimized synchronous group,patients underwent contrast transesophageal echocardiography(cTEE),which was used as the gold standard for diagnosing patent foramen ovale(PFO).The consistency of optimized cTCD combined with cTTE synchronous detection in the diagnosis and grading of PFO was evaluated.The time intervals between the VM and injection of agitated saline,as well as the cardiac cycle,were recorded in the optimized protocol.The correlation between these procedural time intervals and cardiac cycles was analyzed.
Results A total of 342 patients who underwent RLS screening due to dizziness,headache,syncope,or cryptogenic stroke were included in the study.Among them,99 were male and 243 were female,with a mean age of(38.3±14.8)years.The positive rates of RLS in the optimized synchronous group(192 patients)and the optimized cTCD group(112 patients)were higher than that in the non-optimized cTCD group(38 patients)(78.13％vs.47.37％,P<0.001;58.93％vs.47.37％,P<0.001).Among the 121 patients in the optimized synchronous group who completed cTEE examination,111 had RLS caused by PFO(58 with RLS solely from PFO and 53 with combined pulmonary-level RLS),and 10 had isolated pulmonary-level RLS.The optimized synchronous cTCD combined with cTTE synchronous detection showed moderate consistency with cTEE in PFO grading(κ=0.44).The optimized synchronous group demonstrated good consistency and procedural efficiency in timing control,with median time intervals of 5.0 seconds(7.0 median cardiac cycles)from the start of agitated saline injection to VM release(injection→VM release),and 2.0 seconds(2.0 median cardiac cycles)from VM release to the first microbubble detection by cTCD(VM release→bubble).The time intervals between procedural points and cardiac cycles showed positive correlations(injection→VM release:r=0.645,P<0.001;VM release→bubble:r=0.827,P<0.001).
Conclusions The optimized cTCD combined with cTTE synchronous detection showed a higher positive rate of RLS compared to optimized cTCD alone or conventional cTCD alone,demonstrating superior procedural guidance.关键词
对比增强经颅多普勒超声/对比增强经胸超声心动图/对比增强经食管超声心动图/右向左分流Key words
Contrast transcranial Doppler/Contrast transthoracic echocardiography/Contrast transesophageal echocardiography/Right-to-left shunt分类
医药卫生
