经食管超声心动图及经颅多普勒定量评价卵圆孔未闭分流严重程度的临床应用。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-04-03 DOI:10.1016/j.jstrokecerebrovasdis.2025.108306

Philip Y. Sun , Jonathan M. Tobis , Samuel A. Daneshvar , Rodel C. Alfonso , David S. Liebeskind , Jeffrey L. Saver

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引用次数: 0

摘要

背景：经食管超声心动图（TEE）显示3个心动周期内出现大的生理性分流，定义为bbb20左心房微泡，是隐源性缺血性卒中患者卵圆孔未闭（PFO）闭合的随机试验证实的指征。治疗医生从临床TEE报告中获得这些信息的频率尚未得到很好的描述。方法：在连续缺血性脑卒中患者中，提取临床TEE报告的分流管大小特征，并与同一患者的经颅多普勒（TCD）正式分流管分级和中央Core Lab TEE量化评估进行比较。结果：77例患者中位年龄64岁（IQR 56 ~ 73），女性33例（43%）。在TEE患者中，60例（78%）通过气泡研究评估分流存在，5例（7%）通过直接多普勒检查评估分流存在，12例（16%）两种方法都没有。在气泡研究患者中，25例（42%）出现可能由PFO引起的右至左分流（RLS）。4例（16%）患者的RLS严重程度在临床报告中被量化，21例（84%）患者仅使用非正式描述性术语-“小/轻度/轻微”（13例），“中度/中等”（6例）和“严重”（1例）。在19例同样接受TCD的患者中，RLS严重程度在所有临床报告中都被量化。正式量化TEE分流的临床TEE报告和TCD量化之间的分流严重程度一致性为100%(3/3)，而使用非正式描述的15份TEE报告的分流严重程度一致性较差（3/ 15,20 %）。对于存在大分流，PFO关闭的指征，临床TEE非正式描述和TCD在5/15（33%）的患者中不一致。结论：量化的、基于证据的PFO分流严重程度评分出现在每6个TEE报告中不到1个，非量化的、非正式的大小估计与TCD分流严重程度量化相关性较差。在所有临床卒中患者TEE报告中纳入正式的PFO分流管尺寸量化将有助于患者管理。

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Quantification of patent foramen ovale shunt severity by transesophageal echocardiogram and transcranial doppler in routine clinical practice

Background

The presence of a large physiologic shunt, defined as >20 left atrial microbubbles within 3 cardiac cycles on transesophageal echocardiography (TEE), is a randomized trial-validated indication for patent foramen ovale (PFO) closure in patients with otherwise cryptogenic ischemic stroke. The frequency with which this information is available to treating physicians from clinical TEE reports has not been well-delineated.

Methods

Among consecutive ischemic stroke patients, clinical TEE report shunt size characterizations were abstracted and compared to transcranial Doppler (TCD) formal shunt grades in the same patients and to central Core Lab TEE quantified assessments.

Results

Among 77 patients, median age was 64 (IQR 56-73), and 33 (43 %) female. On TEE, shunt presence was assessed by bubble study in 60 (78 %), direct Doppler alone in 5 (7 %), and neither in 12 (16 %). Among bubble study patient, a right-to-left shunt (RLS) potentially due to PFO was present in 25 (42 %). RLS severity was quantified on the clinical report in 4 (16 %) patients and only with informal descriptive terms in 21 (84 %) - “small/mild/trace” (13 cases), “moderate/medium” (6), and “large” (1). In the 19 patients also undergoing TCD, RLS severity was quantified in all clinical reports. Shunt severity agreement between clinical TEE reports and TCD quantification was 100 % (3/3) for formally quantified TEE shunts but poor (3/15, 20 %) for the15 TEE reports using informal descriptions. For presence of a large shunt, an indication for PFO closure, clinical TEE with informal descriptions and TCD were incongruent in 5/15 (33 %) of patients.

Conclusions

Quantified, evidence-based ratings of PFO shunt severity were present in <1 of every 6 TEE reports, and unquantified, informal size estimates correlated poorly with TCD quantification of shunt severity. Patient management would be aided by inclusion of formal PFO shunt size quantification in all clinical stroke patient TEE reports.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.