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リウマチ性心疾患における左心房血栓の二次元エコー心臓診断. 臨床病理学的研究である
Circulation
|February 1, 1983
まとめ
2次元エコーカルディオグラフィーは,心筋リウマチ性疾患の患者の左心房栓の検出に適度な精度を示しています. 画像技術では,約半数の血栓,特に左心房付属体の血栓が検出されなかった.
科学分野:
- 心臓病学 心臓病学
- メディカルイマージング (医学イメージング)
- 心臓外科手術について
背景:
- リウマチ性心臓病 (RHD) はしばしば左心房の異常を引き起こし,血栓形成のリスクを高めます.
- 左心房栓塞の正確な検出は,特に心臓手術の前に,血栓栓塞性の合併症を予防するために非常に重要です.
- 二次元エコーカルディオグラフィ (2DE) は,心臓の構造を評価し,血栓を検出するために使用される主要なイメージング方式です.
研究 の 目的:
- 2次元エコーカルディオグラフィ (2DE) の診断精度を評価し,心筋弁外科手術を受ける心筋リウマチ性心疾患の患者における左心房栓の特定.
- この特定の患者集団における左心房血栓検出のための2DEの感度および特異性を決定する.
主な方法:
- リウマチ性心疾患の患者293人を対象とした前向きな研究で,18ヶ月間,オープンハートミトラ弁手術を受けた.
- 二次元のエコーカルディオグラフィの記録は,左心房トロンビーの存在を検証した.
- 血栓の診断の確認は,直接的な手術内検査と本体病理学的検査に基づいていました.
主要な成果:
- 2次元エコーカルディオグラフィーは,293人の患者のうち33人の左心房栓を特定し,そのうち30人が手術内および組織病理学的に確認されました (特異性98.8%).
- 左心房トロンビを検出するための2DEの全体的な感度は58.8%で,21のトロンビを逃した.
- 見逃した血栓のうち,11個は左心房付属体に位置し (2DEによって完全に見逃された),10個は左心房腔に位置していた. 付属体トロンビを除いて,2DEの感受性は,腔体トロンビに対する感受性が75.0%に改善されました.
結論:
- 二次元エコーカルディオグラフィは,高特異性だが,リウマチ性心疾患の患者における左心房栓の検出に限られた感度を示している.
- 左心房付属体は,2DE検出の難しい場所であり,誤診に大きく貢献しています.
- この高リスクグループにおける左心房血栓の総合的な検出を改善するために,さらなる進歩または補完的な画像技術が必要になる可能性があります.
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