Diagnosis of patent foramen ovale by transesophageal contrast echocardiography

Stöllberger, Claudia; Schneider, Barbara; Abzieher, Friedrich; Wollner, Thomas; Meinertz, Thomas; Slaný, J

doi:10.1016/0002-9149(93)90521-d

Cited by 27 publications

(6 citation statements)

References 4 publications

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“…There is notable variability between different observers in the detection of PFO unless the TEE technique and the criteria of PFO have been standardized. 29 Also, the correct performance of VM is of vital importance for optimal results. The results may remain false-negative in patients who are not able to perform VM properly either because of a neurological disability or because of intolerance of the probe in the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Ear Oximetry: A Noninvasive Method for Detection of Patent Foramen Ovale

Karttunen

Ventilä

Ikäheimo

et al. 2001

Stroke

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Background and Purpose-Patent foramen ovale (PFO) may play an important role as a risk factor for ischemic stroke and some other neurological conditions. There is a need for low-cost and noninvasive methods for the detection of PFO. This study evaluates the accuracy of two simple bedside tests, the dye dilution method and ear oximetry, in the detection of PFO. Methods-Dye dilution curves and ear oximetry recordings with a noninvasive ear densitometer were obtained from consecutive cryptogenic stroke patients referred for contrast transesophageal echocardiography (TEE). All test results were blindly assessed for the presence of PFO. Sensitivity and specificity were calculated with TEE used as a reference method. statistics were used to measure interrater agreement. Results-Dye dilution curves were obtained from 67 patients. Dye dilution correctly diagnosed 35 of the 46 patients who had PFO in TEE and all the 21 patients without PFO. Thus, the sensitivity (95% CI) of the dye dilution method was 76% (61% to 87%) and its specificity 100% (84% to 100%). Ear oximetry was done on 83 patients. Oximetry correctly diagnosed 45 of the 53 patients who had PFO in TEE and all of the 30 patients without PFO. Thus, the sensitivity of ear oximetry was 85% (72% to 93%) and its specificity 100% (88% to 100%). The interrater agreement was excellent ( value 0.94 for dye dilution and 0.90 for oximetry). Conclusions-Dye dilution and oximetry are both sensitive and specific methods for the detection of PFO. Oximetry has the following primary advantages over the currently available diagnostic methods: it is noninvasive, safe, and inexpensive and causes no discomfort for the patient. We suggest that oximetry could be used as a first-line screening method for PFO in patients with cryptogenic stroke. Ear oximetry also has potential use in epidemiological studies.

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Section: Discussionmentioning

confidence: 99%

Ear Oximetry: A Noninvasive Method for Detection of Patent Foramen Ovale

Karttunen

Ventilä

Ikäheimo

et al. 2001

Stroke

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“…The modified Rankin Scale (mRS) was assessed at 90 days by a stroke-trained physician or stroke study nurse certified in mRS via in-person or phone interview. 15,16 We defined academic months as well as 4 academic quarters (3 months each) with the first academic month starting on July 1 st and the first academic quarter ranging from July through September 2013 to determine whether the ED-LOS varied over the course of the academic year. To determine whether the time of patient presentation to the ED was associated with the ED-LOS or outcome we stratified the time to presentation into 7AM-3PM, 3PM-11PM, and 11PM to 7 AM shifts, which most closely represent both neurology and ED staff shifts.…”

Section: Methodsmentioning

confidence: 99%

Emergency Department Length of Stay and Outcome after Ischemic Stroke

Minaeian

Patel

Essa

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background Emergency department length-of-stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke. Methods Retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n=325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin scale [mRS] score >2), respectively. Results The median ED-LOS in the cohort was 5.8 hours. For patients admitted to the inpatient stroke ward (n=160) versus neurointensive care unit (NICU; n=165), the median ED-LOS was 8.2 hours versus 3.7 hours, respectively. On multivariable linear regression, NICU admission (P<0.001), endovascular stroke therapy (P=0.001), and thrombolysis (P=0.021) were inversely associated with the ED-LOS. Evening shift presentation was associated with a longer ED-LOS (P=0.048). On multivariable logistic regression, a greater admission NIHSS (P<0.001), worse pre-admission mRS (P=0.001), hemorrhagic conversion (P=0.041), and a shorter ED-LOS (P=0.016) were associated with a poor 90-day outcome. Early initiation of statin therapy (P=0.049), endovascular stroke therapy (P=0.041), NICU admission (P=0.029), and evening shift presentation (P=0.035) were associated with a good 90-day outcome. Conclusions In contrast to prior studies, a shorter ED-LOS was associated with a worse 90-day functional outcome, possibly reflecting prioritized admission of more severely affected patients who are at high risk for a poor functional outcome.

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“…26 Findings that argue against the association between PFO and cryptogenic stroke include the high prevalence of PFO in all subtypes of stroke 27 and the low likelihood of finding a source of thrombus for paradoxical embolism in stroke patients with PFO ( Table 2). [23][24][25][30][31][32][33] In addition, small (Ͻ1-2 mm) clots that are beyond the resolution of TEE transducers may be missed, and migration or lysis of clots can occur before diagnostic imaging has been performed. These confounding factors underscore the difficulties in establishing a cause-effect relationship between PFO and paradoxical embolism.…”

Section: Association Of Pfo and Strokementioning

confidence: 99%

Patent Foramen Ovale in Cryptogenic Stroke

Wu¹,

Malouf²,

Dearani³

et al. 2004

Arch Intern Med

130

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There is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalva-inducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.

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Diagnosis of patent foramen ovale by transesophageal contrast echocardiography

Cited by 27 publications

References 4 publications

Ear Oximetry: A Noninvasive Method for Detection of Patent Foramen Ovale

Ear Oximetry: A Noninvasive Method for Detection of Patent Foramen Ovale

Emergency Department Length of Stay and Outcome after Ischemic Stroke

Patent Foramen Ovale in Cryptogenic Stroke

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