Abstract
The aim of this research was to compare the sensitivity and positivepredictive value of contrast transcranial Doppler (c-TCD), contrast transthoracic echocardiography (c-TTE), and contrast transesophageal echocardiography (c-TEE), to determine the best method for diagnosing patent foramen ovale (PFO) and to provide a reference for the further improvement of clinical practice. We investigated 161 patients who suffered from migraines, cryptogenic stroke, TIA, and cerebral infarction of unknown cause. All patients underwent transcatheter examination, and the results of the right heart catheterization(RHC) were considered the gold standard for PFO diagnosis. The present study revealed that c-TTE with the Valsalva maneuver had a higher sensitivity in detecting PFO related right-to-left shunt (PFO-RLS), c-TCD performed similarly to c-TEE but maybe produce more false positives. Moreover, when we observed color shunt from the slit-like channel between the septum primum and the septum secundum on TEE, the positivepredictive value was the highest. Patients with suspectedPFO should be examined with c-TTE and c-TEE for confirmation. When there were a large numberof bubbles in the left heart, especially in the presence of color shunt, the positivepredictive value was the highest. The positive results of c-TCD only point out the presence of right-to-left shunt and cannot exclude extracardiac shunt, so c-TCD should not be used as a screen for PFO, additional measures such as c-TTE and c-TEE should be used.
Highlights
In recent years, the definition of embolic strokes of undetermined source (ESUS) emerged as a new clinical construct to characterize cryptogenic stroke (CS),most of the patients were young and had no medical history of hypertension, diabetes or hyperlipidemia, routine imageological examination failed to detect significant vascular abnormalities (Hart et al, 2017)
For the suspected patients, can examine with contrast transcranial Doppler (c-TCD) first, if we get the positive results, contrast- transthoracic echocardiography (c-transthoracic echocardiography (TTE)) and contrast- transesophageal echocardiography (c-transesophageal echocardiography (TEE)) should be taking to further confirmed. These findings may be helpful in the diagnosis of patent foramen ovale in practice
As put the results of the right heart catheterization (RHC) as the gold standard for patent foramen ovale (PFO) diagnosis, 141 of the 161 patients studied were diagnosed with PFO, 18 patients cannot be diagnosed with PFO, 2 patients were diagnosed as pulmonary arteriovenous malformation, the morbidity of PFO was 88.17% (Table 1)
Summary
The definition of embolic strokes of undetermined source (ESUS) emerged as a new clinical construct to characterize cryptogenic stroke (CS),most of the patients were young and had no medical history of hypertension, diabetes or hyperlipidemia, routine imageological examination failed to detect significant vascular abnormalities (Hart et al, 2017). Patent foramen ovale (PFO) has been reported to be strongly associated with a number of diseases, including cryptogenic stroke (Mojadidi et al, 2018), transient ischemic attack (TIA) (Khan et al, 2016), migraine (Smith and Williams, 2017), peripheral arterial embolism, and decompression sickness (Rushdi et al, 2011). Patent foramen ovale (PFO) has been reported to be strongly associated with embolic strokes of undetermined source (ESUS), including cryptogenic stroke, transient ischemic attack (TIA), migraine, and so on.The aim of this research was to compare the sensitivity and positive predictive value of contrast transcranial Doppler (c-TCD), contrast- transthoracic echocardiography (c-TTE) versus contrast- transesophageal echocardiography (c-TEE), to find which is the best method to diagnose patent foramen ovale (PFO), provides reference for the further improvement of clinical
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