SENSITIVITY OF TRANSCRANIAL DOPPLER AND TRANSOESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DETECTION OF PATENT FORAMEN OVALE IN CRYPTOGENIC STROKE

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7± in migraine with aura (MA) patients, 33.7± in migraine without aura (MoA) patients, 33.8± in young stroke patients and 20.5± in elderly stroke patients ( P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1± and 25± ( P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

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Current status of transcatheter closure of patent foramen ovale

Gaceta Médica de Caracas - Supplement 1 ◽

10.47307/gmc.2020.128.3.8 ◽

2020 ◽

Vol 128 (3) ◽

pp. 296-306

Author(s):

Igor F. Palacios

Keyword(s):

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Decompression Sickness ◽

Adult Population ◽

Cryptogenic Stroke ◽

Current Status ◽

Diagnostic Tools ◽

Foramen Ovale ◽

Exercise Induced ◽

Ischemic Attack

A patent foramen ovale (PFO) is a highly prevalent structure among the adult population. It allows the shunt of blood through the inter-atrial septum and has been associated with cryptogenic stroke, transient ischemic attack, significant right to left shunting resulting in resting and exercise-induced hypoxemia, platypnea orthodeoxia syndrome, and decompression sickness after scuba diving and migraines. Currently, transthoracic and transesophageal echocardiography and transcranial Doppler are the most important diagnostic tools, for the diagnosis of PFO. The sensitivity and specificity of the study depend on the modalities available: transthoracic (TTE), transesophageal (TEE), and transcranial Doppler (TCD), as well as the intravenous use of agitated saline and the site of injection.

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Paradoxical emboli: Clinical importance of transcranial doppler for detection of patent foramen ovale

Medicinski pregled ◽

10.2298/mpns1008445z ◽

2010 ◽

Vol 63 (7-8) ◽

pp. 445-449

Author(s):

Zeljko Zivanovic ◽

Svetlana Ruzicka-Kaloci ◽

Aleksandar Jesic ◽

Biljana Radovanovic ◽

Aleksandra Lucic-Prokin ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Doppler Sonography ◽

Contrast Echocardiography ◽

Cryptogenic Stroke ◽

Transcranial Doppler Sonography ◽

Foramen Ovale ◽

Predictive Values ◽

Bubble Test

A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, with paradoxical embolism as the major pathogenetic mechanism. The standard procedure for the detection of a patent foramen ovale is transesophageal echo?cardiography. Transcranial Doppler sonography with bubble test is almost as reliable as transesophageal echocardiography. Seventeen patients with acute ischemic stroke and transient ischemic attacks hospitalized at the Department of Neurology in Novi Sad underwent examinations to detect a patent foramen ovale, which was found in 55.6% of patients with cryptogenic stroke. The average age of these patients was 30.6 years. Transcranial Doppler sonography showed 100% sensitivity and 100% specificity for the predicti?on of right-to-left shunts proven by transesophageal contrast echocardiography. Both positive and negative predictive values in our group of patients were 1. Transcranial Doppler with bubble test is a reliable method for the detection of a patent foramen ovale, with a high level of sensitivity and specificity which is comparable with transesophageal echocardiography. Moreover, it is cheaper and more comfortable than transesophageal echocardiography, and should be used routinely in neurological practice.

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Comparison of Transthoracic Echocardiography, Transesophageal Echocardiography, and Transcranial Doppler in the Detection of Patent Foramen Ovale as the Etiology for Cryptogenic Stroke

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479318816983 ◽

2018 ◽

Vol 35 (2) ◽

pp. 127-133

Author(s):

Madison B. Stafford ◽

Jennifer E. Bagley ◽

Dora DiGiacinto

Keyword(s):

Transesophageal Echocardiography ◽

Transcranial Doppler ◽

Transthoracic Echocardiography ◽

Gold Standard ◽

Patent Foramen Ovale ◽

Doppler Sonography ◽

Cryptogenic Stroke ◽

Transcranial Doppler Sonography ◽

Young Patients ◽

Foramen Ovale

The correlation between cryptogenic stroke and patent foramen ovale is high in young patients. Currently, transesophageal echocardiography is the gold standard for detection. However, it is invasive and limits Valsalva maneuvers. This article reviews the diagnostic accuracy of the three modalities: transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler. The results suggest that transcranial Doppler sonography is an accurate, easily accessible procedure for detecting patent foramen ovale and should be considered an excellent alternative to transthoracic or transesophageal echocardiography. Transesophageal echocardiography is still necessary for patients who require treatment. The combination of transcranial Doppler and transesophageal echocardiography provides the highest level of information regarding the complete diagnosis of patent foramen ovales.

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Detection of patent foramen ovale by transcranial Doppler and carotid duplex ultrasonography: a comparison with transoesophageal echocardiography

Clinical Physiology ◽

10.1046/j.1365-2281.1998.00106.x ◽

1998 ◽

Vol 18 (4) ◽

pp. 327-330 ◽

Cited By ~ 24

Author(s):

Anders T. Nygren ◽

Tomas Jogestrand

Keyword(s):

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Transoesophageal Echocardiography ◽

Duplex Ultrasonography ◽

Foramen Ovale ◽

Carotid Duplex ◽

Carotid Duplex Ultrasonography

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A comparison of contrast transthoracic echocardiography and contrast transcranial Doppler in cryptogenic stroke patients with patent foramen ovale

Brain and Behavior ◽

10.1002/brb3.1283 ◽

2019 ◽

Vol 9 (5) ◽

pp. e01283 ◽

Cited By ~ 2

Author(s):

Jie Chen ◽

Luyun Chen ◽

Wangwang Hu ◽

Xianda Ni ◽

Zengrui Zhang ◽

...

Keyword(s):

Transcranial Doppler ◽

Transthoracic Echocardiography ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Stroke Patients

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Incidental diagnosis of four pulmonary arteriovenous fistulas during patent foramen ovale closure: a case report

Cardiology in the Young ◽

10.1017/s1047951120002152 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1363-1365

Author(s):

Alessandro Andreis ◽

Gabriella Agnoletti ◽

Paolo Scacciatella

Keyword(s):

Patent Foramen Ovale ◽

Clinical Case ◽

Septal Defect ◽

Cryptogenic Stroke ◽

Young Patients ◽

Transoesophageal Echocardiography ◽

Paradoxical Embolism ◽

Foramen Ovale ◽

Arteriovenous Fistulas ◽

Pulmonary Arteriovenous Fistulas

AbstractCryptogenic cerebral ischemia in young patients is commonly ascribed to paradoxical embolism. We report the clinical case of a young patient with cryptogenic stroke and a patent foramen ovale, undergoing percutaneous closure of atrial septal defect. Contrast transoesophageal echocardiography at the end of the procedure demonstrated massive late residual right-to-left shunt, due to the coexistence of pulmonary arteriovenous fistulas that were subsequently closed. Routinary adoption of contrast transoesophageal echocardiography at the end of patent foramen ovale closure interventions may be useful to detect early and late residual shunts. Late residual shunts may be due to pulmonary fistulas, a well-known risk factor for recurrent thromboembolic events.

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The Efficacy of Contrast Transthoracic Echocardiography and Contrast Transcranial Doppler for the Detection of Patent Foramen Ovale Related to Cryptogenic Stroke

BioMed Research International ◽

10.1155/2020/1513409 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Jing Yang ◽

Huiqin Zhang ◽

Yumeng Wang ◽

Shiquan Zhang ◽

Tingyu Lan ◽

...

Keyword(s):

Likelihood Ratio ◽

Transcranial Doppler ◽

Transthoracic Echocardiography ◽

Gold Standard ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Negative Likelihood Ratio ◽

Foramen Ovale ◽

Sensitivity Specificity ◽

Grade Iii

Background. Patent foramen ovale (PFO) has been linked to the pathophysiology of cryptogenic stroke. Contrast transesophageal echocardiography (cTEE) is the current gold standard for PFO diagnosis, but it has the disadvantage of being semi-invasive and does not exempt from risks. As a diagnostic test, the efficacy of contrast transthoracic echocardiography (cTTE) and contrast transcranial Doppler (cTCD) is controversial. This study is aimed at investigating the efficacy of cTTE and cTCD versus cTEE in PFO detection, exploring a more cost-effective and reliable method for the diagnosis of PFO related to cryptogenic stroke. Methods. From August 2019 to January 2020, a total of 213 patients with suspected PFO were included in our study. All patients underwent cTEE, cTCD, and cTTE examinations. cTTE3 was named for using a cutoff of 3 beats to detect PFO during cTTE, and cTTE5 represented a cutoff of 5 beats. A cutoff of cTCD grade III was named cTCD III. A cutoff of grade IV was named cTCD IV. cTTE3+cTCD IV was used for the combination of a cutoff of 3 beats during cTTE with grade IV of cTCD. cTTE5+cTCD III combined a cutoff of 5 beats during cTTE with cTCD grade III. Taking cTEE as the gold standard, we compared the sensitivity, specificity, negative likelihood ratio (-LR), and misdiagnosis rate for PFO detection among the above methods. Results. A total of 161 of 213 (76%) patients had PFO confirmed by cTEE. With the spontaneous Valsalva maneuver, the sensitivity, specificity, negative likelihood ratio (-LR), and misdiagnosis rate of cTTE3 in PFO diagnosis were 60%, 90%, 44%, and 10%, respectively, and those for cTTE5 were 76%, 78%, 31% and 22%, respectively. The sensitivity, specificity, negative likelihood ratio (-LR), and misdiagnosis rate of cTCD III were 80%, 71%, 29%, and 29%, respectively, while those for cTCD IV were 55%, 90%, 49%, and 10%, respectively. When cTTE and cTCD were combined to diagnose PFO, the specificity and misdiagnosis rate were significantly improved, especially cTTE3+cTCD IV, with 100% specificity and a misdiagnosis rate of 0. Conclusion. cTTE or cTCD can be used for preliminary PFO related to cryptogenic stroke findings. The combination of the two methods can improve the specificity of PFO diagnosis, especially using the cutoff of cTTE3+cTCD IV.

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