不同激发方式在右心声学造影诊断卵圆孔未闭中的价值比较

目的 比较不同激发方式在右心声学造影诊断卵圆孔未闭(PFO)右向左分流(RLS)中的应用价值。方法 选取2021年6月至2022年7月在宜宾市第二人民医院就诊的247例疑似PFO患者为研究对象，分别在静息状态(RS)、传统Valsalva动作(CM)、改良Valsalva动作(BM)及咳嗽动作(COF)状态下完成右心声学造影(cTTE)检查，并完善经胸超声心动图(TTE)和经食管超声心动图(TEE)检查。结果 BM对中-大量PFO-RLS检出率高于CM和COF(P<0.05);COF-BM对中-大量PFO-RLS检出率高于其他联合方式(P<0.05);COF-CM-BM和RS-COF-BM对中-大量PFO-RLS的检出率比较，差异无统计学意义(P>0.05);以TEE为诊断PFO的金标准，cTTE的灵敏度和AUC值高于TTE,分别为92.1%和81.5%,RS-COF-BM的灵敏度最高，AUC值较高。结论 cTTE适用于PFO的筛查，单独激发方式宜选用BM,激发方式联合使用宜选用COF-BM。

Comparison of the value of different excitation methods in the diagnosis of patent foramen ovale by contrast echocardiography

Objective Tocomparetheapplicationvalueofdifferentexcitationmethodsinthediagnosisofpatentforamenovale(PFO)relatedrighttoleftshunt(RLS)bycontrasttransthoracicechocardiography(cTTE).Methods Atotalof247patientswithsuspectedPFOintheSecondPeople''sHospitalofYibinfromJune2021toJuly2022wereselectedasthestudysubjects.AllpatientsunderwentthecTTEexaminationindifferentstates,includingrestingstate (RS),conventionalValsalvamaneuver(CM),modifiedValsalvamaneuver(BM)andcough (COF).Transthoracicechocardiography(TTE)andtransesophagealechocardiography (TEE)examinationswerealsoperformed.Results ThedetectionrateofmoderatetomediumlargePFO-RLSinBMwashigherthanthatinCMandCOF(P<0.05).ThedetectionrateofmoderatetomediumlargePFO-RLSinCOF-BMwashigherthanthatinothercombinedmethods(P<0.05).TherewasnosignificantdifferenceinthedetectionrateofmoderatetomediumlargePFO-RLSbetweenCOF-CM-BMandRS-COF-BM (P<0.05).TakingTEEasthegoldstandardforthediagnosisofPFO,cTTEhadhighersensitivityandAUCvaluethanTTE (92.1% and81.5%,respectively),andRS-COF-BMhadthehighestsensitivityandhigherAUCvalueforPFO-RLS.Conclusion cTTEcanbeusedforscreeningpatientswithPFO.BMispreferredasthesingleexcitationmethodintheprocessofcTTE.COF-BMispreferredasthecombinationofexcitationmethodsintheprocessofcTTE.