Application of right heart acoustic cardiography combined with transesophageal echocardiography in the diagnosis of occult patent foramen ovale classification

doi:10.3760/cma.j.cn441417-20250520-19007

Abstract

Abstract:

Objective　To explore the application value of right heart acoustic cardiography (RHAC) combined with transesophageal echocardiography (TEE) in the diagnosis of the classification of occult patent foramen ovale (PFO). Methods　A retrospective study was conducted on 98 suspected PFO patients at Tongchuan People's Hospital from June 2021 to June 2024, who presented with unexplained stroke, migraine, transient ischemic attack, or unexplained syncope and underwent RHAC and TEE examinations. Among them, there were 42 males and 56 females, with an age range of 21 to 68 (43.7±12.5) years old. RHAC used the modified Valsalva maneuver to enhance the visualization of right to left shunt, while TEE confirmed the anatomical structure and shunt characteristics of PFO. PFO was classified into three types based on the degree of shunt and anatomical features: type I (minimal shunt), type II (moderate shunt), and type III (significant shunt). The gold standard was clinical follow-up combined with surgical verification. The study analyzed the differences in the detection rate and classification accuracy between the two methods and the advantages of their combined use. Statistical analysis was conducted using the χ² test, McNemar test, Pearson correlation analysis, enter method multiple linear regression analysis, and receiver operating characteristic curve (ROC). Results　Of the 98 suspected PFO patients, 73 (74.49%) were ultimately diagnosed with PFO. RHAC detected 67 cases of PFO with a sensitivity of 91.78% and a specificity of 100.00%. TEE detected 59 cases of PFO with a sensitivity of 80.82% and a specificity of 100.00%. Combined diagnosis (positive in either method) detected 73 cases, with a sensitivity of 100.00% and a specificity of 100.00%. In the classification diagnosis, the combined determination achieved a accuracy rate of 100.00% for the diagnosis of type I, type II, and type III PFO. Among the patients with occult PFO, there were 25 cases with atrial septal aneurysm and 16 cases with Chiari's network. The detection rates of atrial septal aneurysm by RHAC and TEE were 80.00% (20/25) and 100.00% (25/25), respectively, and the detection rates of Chiari's network were 56.25% (9/16) and 100.00% (16/16), respectively; there were statistically significant differences in the detection rates of atrial septal aneurysm and Chiari's network between the two examination methods (χ²=5.56, P=0.018; χ²=9.14, P=0.003). The number of RHAC microbubbles was positively correlated with the size of the PFO opening measured by TEE (r=0.785, P<0.001). The predictive model established by combining the two parameters of microbubble quantity and opening size had a macro-average AUC (area under the curve) of 0.899 (95%CI: 0.848 - 0.951) for PFO classification. Conclusion　RHAC combined with TEE examination provides a more comprehensive evaluation method for the classification diagnosis of occult PFO, improving diagnostic accuracy and providing important evidences for clinical intervention decisions.

Key words:

Patent foramen ovale, Right heart acoustic cardiography, Transesophageal echocardiography, Classification diagnosis, Occult, Right to left shunt

摘要：

目的　探讨右心声学造影（right heart acoustic cardiography，RHAC）联合经食管超声心动图（transesophageal echocardiography，TEE）在隐匿性卵圆孔未闭（patent foramen ovale，PFO）分型诊断中的应用价值。方法　回顾性选取2021年6月至2024年6月铜川市人民医院因不明原因脑卒中、偏头痛、短暂性脑缺血发作或不明原因晕厥等临床表现接受RHAC和TEE检查的疑似PFO患者98例，其中男42例，女56例，年龄21～68（43.7±12.5）岁。RHAC采用改良Valsalva动作增强右-左分流显示，TEE用于确认PFO解剖结构及分流特征。根据分流量级及解剖特点将PFO分为Ⅰ型（微量分流）、Ⅱ型（中量分流）、Ⅲ型（大量分流）。以临床随访结合手术验证结果为金标准，分析两种方法在PFO检出率、分型准确性方面的差异及联合应用的优势。采用χ²检验、McNemar检验、Pearson相关性分析、enter法多元线性回归、受试者操作特征曲线（ROC）进行统计学分析。结果　98例疑似PFO患者中，最终确诊PFO 73例（74.49%）。单独RHAC检出PFO 67例，灵敏度91.78%，特异度100.00%；单独TEE检出PFO 59例，灵敏度80.82%，特异度100.00%；联合判定（任一方法阳性即为阳性）检出73例，灵敏度100.00%，特异度100.00%。在分型诊断中，联合判定对Ⅰ型、Ⅱ型、Ⅲ型PFO的诊断准确率均为100.00%。隐匿性PFO患者中合并房间隔瘤25例，合并Chiari网16例。RHAC、TEE对房间隔瘤的检出率分别为80.00%（20/25）、100.00%（25/25），对Chiari网的检出率分别为56.25%（9/16）、100.00%（16/16）；不同检查方法对房间隔瘤、Chiari网的检出率差异均有统计学意义（χ²=5.56，P=0.018；χ²=9.14，P=0.003）。RHAC微泡数量与TEE测量的PFO开口大小呈正相关（r=0.785，P<0.001）。联合微泡数量、开口大小两项参数建立的预测模型对PFO分型的宏平均曲线下面积（AUC）为0.899（95%CI：0.848～0.951）。结论　RHAC联合TEE检查为隐匿性PFO的分型诊断提供了更全面的评估手段，可提高诊断准确性，为临床干预决策提供了重要依据。

关键词:

卵圆孔未闭, 右心声学造影, 经食管超声心动图, 分型诊断, 隐匿性, 右-左分流

Yin Xiaoling, Wang Jing, Li Yanting, Kong Yanliang.

Application of right heart acoustic cardiography combined with transesophageal echocardiography in the diagnosis of occult patent foramen ovale classification [J]. International Medicine and Health Guidance News, 2025, 31(19): 3202-3207.

阴肖玲王静李彦婷孔延亮.

右心声学造影联合经食管超声心动图在隐匿性卵圆孔未闭分型诊断中的应用 [J]. 国际医药卫生导报, 2025, 31(19): 3202-3207.

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