Contrast-enhanced transthoracic echocardiography applied in evaluation of pulmonary right-to-left shunt: A preliminary study

Feng, Cheng; Luo, Tingting; Luo, Yongfang; Zhao, Ning; Huang, Kun; Xiao, Chang

doi:10.1016/j.compmedimag.2018.04.007

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…The results of this study showed that the diagnosis of cTTE resulted in 13 (10.57%) false negatives and six (4.88%) false positives. The low sensitivity of cTTE may be related to a failure to effectively increase right atrial pressure, poor image quality due to air interference in the lung images, image instability, and the inadequate filling of the right atrial contrast due to an oversized inferior vena cava valve, while the false positives may be related to inadequate contrast elimination from the previous ultrasound examination, and the presence of pulmonary arteriovenous fistula, and the physiologic passing through the lungs during the strong provocation ( 30 - 32 ). RLS in six false positives were confirmed as pulmonary shunt by cTEE in our study.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of contrast-enhanced ultrasonography for patent foramen ovale detection

Xu,

Tian,

Hao

et al. 2024

J Thorac Dis

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Background Patent foramen ovale (PFO) has been associated with migraine, cryptogenic stroke (CS), and hypoxemia. However, which examination method is most reliable remains controversial. This study sought to investigate the diagnostic value of contrast-enhanced ultrasonography (cU), including contrast-enhanced transcranial Doppler (cTCD), contrast transthoracic echocardiography (cTTE), and contrast transesophageal echocardiography (cTEE), for PFO; and to determine the best diagnostic strategy. Methods This retrospective observational study included a total of 147 consecutive patients suspected PFO at The First Hospital of Shanxi Medical University between October 2019 and January 2022. The patients also underwent cTCD, cTTE, and cTEE examinations. The standard for the diagnosis of PFO was confirmation of the presence of PFO by color Doppler flow signals or contrast microbubbles (MBs) passing through the foramen ovale. Results A total of 123 patients were diagnosed with PFO and 24 patients without PFO during the study period. The detectable rates of cTCD, cTTE, and cTEE were 120 (97.56%), 110 (89.43%), and 121 (98.37%), respectively. The sensitivity between cTCD and cTEE for PFO were comparable [97.56%, 95% confidence interval (CI): 92.5% to 99.4% vs . 98.37%, 95% CI: 93.7% to 99.7%; P>0.99], and the sensitivity of both were higher than that of cTTE (89.43%, 95% CI: 82.3% to 94.0%; P=0.02 and P=0.001, respectively). In addition, the specificity of cTEE for PFO was significantly higher than that of cTCD (100%, 95% CI: 82.3% to 100.0% vs . 75.00%, 95% CI: 53.0% to 89.4%; P<0.001) and cTTE (100%, 95% CI: 82.3% to 100.0% vs . 75.00%, 95% CI: 53.0% to 89.4%; P<0.001). Further, the semi-quantitative classification ability of cTCD for PFO with right-to-left shunt (RLS) was significantly higher than that of cTTE and cTEE (P=0.02 and P<0.001, respectively), and that of cTTE was significantly higher than that of cTEE (P=0.01). The Spearman analysis showed that the degree of RLS was positively correlated with the inner diameter of the PFO (r=0.695, P<0.001). Conclusions The combination of cTCD and cTEE may provide a favorable strategy for the diagnosis of PFO.

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Section: Discussionmentioning

confidence: 99%

Diagnostic value of contrast-enhanced ultrasonography for patent foramen ovale detection

Xu,

Tian,

Hao

et al. 2024

J Thorac Dis

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“…There was an interval of at least 10 minutes between the two methods. Patients were also instructed to perform an effective Valsalva maneuver before the tests in order to reach and maintain a pressure of 40 mmHg for at least 5 seconds[19, 24, 25]. This was performed by blowing into the plastic pipe connected to the manometer device.…”

Section: Methodsmentioning

confidence: 99%

Modified Method of Contrast Transthoracic Echocardiography for the Diagnosis of Patent Foramen Ovale

Zhao

Xie

et al. 2019

BioMed Research International

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Purpose. To compare the sensitivity and specificity of modified and traditional methods of contrast echocardiography of the right portion of the heart in patients with a suspicion of patent foramen ovale (PFO). Methods. The study population consisted of 506 patients with high clinical suspicion of PFO. The traditional Valsalva maneuver consists of expiration against a closed glottis after a full inspiration. A modified Valsalva maneuver was performed with a handmade pressure monitoring device, which measured pressure during performance of the Valsalva maneuver. Modified and traditional methods of contrast echocardiography were performed among all patients. Contrast transesophageal echocardiography (TEE) was regarded as the gold standard. Results. A total of 279 patients with PFO were confirmed by TEE. 259 cases (sensitivity: 92.83%) were detected by a modified method of contrast echocardiography of the right portion of the heart, while 234 cases were detected using the traditional method (sensitivity: 83.87%). The sensitivity of modified contrast echocardiography of the right portion of the heart was significantly higher than that of the traditional method (92.83% vs. 83.87%, P=0.001). However, there was no significant difference in the specificity of the two methods for the diagnosis of PFO (97.35% vs. 96.03%, P=0.431). Additionally, the results of semiquantitative evaluation of PFO using modified method failed to show a more positive rate than shown by the traditional method (Z=−1.782, P=0.075). Conclusions. Modified contrast echocardiography of the right portion of the heart yielded a higher sensitivity than the traditional method, which contributed to the diagnosis of cardiac PFO. The research was a part of a register study (https://register.clinicaltrials.gov/ ClinicalTrials ID: NCT02777359).

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“…A senior radiologist measured the long diameter of the foramen ovale and the inner diameter of the shunt to facilitate the diagnosis of right-to-left shunt and patent foramen ovale. The semi-quantitative grading of the right-to-left shunt was as follows [10]: Grade 0 (no microbubbles in the left heart chamber), Grade 1 (1-10 microbubbles/frame), Grade 2 (11-30 microbubbles/frame), and Grade 3 (>30 microbubbles/frame). The diagnostic criteria for patent foramen ovale were based on the presence of a conspicuous aperture between the second septum and the valve of the foramen ovale, small atrial left-toright shunting between the two, and shunting concentrated at the junction of the second septum and the valve of the foramen ovale, all of which were used to confirm the presence of patent foramen ovale [11].…”

Section: Right Heart Contrast Echocardiographymentioning

confidence: 99%

Predictive value of right heart contrast echocardiography combined with STAF in cardioembolism

2024

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Cardioembolism (CE) is a prevalent cerebrovascular disease in clinical practice. This study aims to assess the predictive efficacy of right heart contrast echocardiography combined with the Score for Targeting Atrial Fibrillation (STAF) for diagnosing CE. A total of 149 patients with CE and 93 patients with non-CE (NCE) were classified into the study group and control group, respectively, and their data were retrospectively analyzed. All patients underwent right heart contrast echocardiography and STAF assessment, and comparative analyses between the groups were performed. In addition, the predictive potential of combining right heart contrast echocardiography with STAF for CE was evaluated, and the CE patients underwent a one-year follow-up to assess survival and prognostic factors. The results of this study showed that patients in the CE group had higher incidences of grade 1 + 2 + 3 right-to-left shunt, patent foramen ovale (PFO) positivity, greater foramen ovale length, larger shunt inner diameter, and higher STAF score compared to the NCE group (p < 0.05). Receiver operating characteristic curve analysis revealed that the predictive values for CE, in terms of right-to-left shunt grade, PFO positivity, foramen ovale length, shunt inner diameter, and area under the curve (AUC) for STAF, were 0.582, 0.570, 0.679, 0.808 and 0.750, respectively. The combined AUC value for all these parameters was 0.905. Univariate and multiple logistic regression analysis indicated that atrial fibrillation, total cholesterol and fibrinogen were not prognostic factors in CE patients (p > 0.05), whereas National Institute of Health stroke scale (NIHSS) score, PFO positivity, foramen ovale length and STAF at admission were prognostic factors (p < 0.05). Therefore, combining right heart contrast echocardiography with STAF may enhance the predictive efficacy for CE.

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Contrast-enhanced transthoracic echocardiography applied in evaluation of pulmonary right-to-left shunt: A preliminary study

Cited by 5 publications

References 24 publications

Diagnostic value of contrast-enhanced ultrasonography for patent foramen ovale detection

Diagnostic value of contrast-enhanced ultrasonography for patent foramen ovale detection

Modified Method of Contrast Transthoracic Echocardiography for the Diagnosis of Patent Foramen Ovale

Predictive value of right heart contrast echocardiography combined with STAF in cardioembolism

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