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

Zhao, Enfa; Du, Yajuan; Xie, Hang; Zhang, Yushun

doi:10.1155/2019/9828539

Cited by 14 publications

(12 citation statements)

References 34 publications

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“…platypnea-orthodeoxia syndrome, and decompression sickness [3,4]. Migraine is a chronic neurological disorder characterised by attacks of moderate or severe headache and reversible neurological and systemic symptoms, and is one of the most prevalent and disabling medical illnesses in the world [5].…”

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confidence: 99%

Prevalence and grade of RLS in migraine: a prospective study of 251 migraineurs by synchronous test of c-TTE and c-TCD

Zhao

Liu²,

Zhou

et al. 2020

Preprint

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Background RLS is considered as a risk factor for migraine, but the correlation between the RLS and migraine remains controversial. To investigate the prevalence and Right-to left shunt (RLS) grade of PFO in patients with migraine (including migraine with aura and without) and assess the association between PFO and migraine. Methods Synchronous test of contrast transthoracic echocardiography (c-TTE) and contrast transcranial Doppler ultrasonography (c-TCD) was conducted in 251 patients with migraine, including 61 migraine with aura (MA) and 189 migraine without aura (MO) and 275 healthy adults. Among these patients, 25 patients with migraine and 14 healthy adults were evaluated by transesophageal echocardiography (TEE). Results (1). The prevalence of permanent RLS, total RLS and large RLS in migraine was significantly higher compared with controls (P = 0.042, < 0.001 and 0.001, respectively). (2). Compared with controls, the positive rate of total RLS and large RLS in MO was increased (P = 0.004 and 0.022 respectively), the positive rate of permanent RLS, total RLS and large RLS in MA was also increased (P < 0.001 for each of the comparisons). The positive rate of permanent RLS and large RLS in MA was significantly higher than in MO (P = 0.004 and 0.011 respectively). (3) The presence of large-size PFO (≥ 2.0 mm) of migraine was higher than that of controls (P = 0.048). Conclusion PFO is associated with increased migraine (especially with aura), when the PFO is permanent RLS, large RLS and large-size PFO (≥ 2.0 mm).

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confidence: 99%

Prevalence and grade of RLS in migraine: a prospective study of 251 migraineurs by synchronous test of c-TTE and c-TCD

Zhao

Liu²,

Zhou

et al. 2020

Preprint

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“…During the cTTE or cTEE studies, a PFO was diagnosed when microbubbles were seen in the left chambers within three cardiac cycles after the opacification of the right chambers. For the cTTE, the extent of the shunt was semiquantified as follows: 0 microbubble (negative result); grade I (mild, 1-10 microbubbles); grade II (moderate, 11-30 microbubbles); and grade III (severe, >30 microbubbles or left ventricle nearly filled with microbubbles) [15]. For the cTEE, quantification of the left atrial was assessed as follows: 0 microbubble (negative result); grade I (mild; 1 to 5 microbubbles), grade II (moderate; 6 to 20 microbubbles), or grade III (severe; >20 microbubbles) [16].…”

Section: Methodsmentioning

confidence: 99%

“…Following recordings in basal condition, it was repeated during a VM. The VM was performed by the patients blowing into a plastic tube connected BioMed Research International to the manometer device [15]. We asked patients to carry out the VM a few seconds before the contrast injection and maintain until the right atrium was filled with the contrast agent.…”

Section: Contrast Transthoracic Echocardiography Examinationmentioning

confidence: 99%

Diagnosis of Patent Foramen Ovale: The Combination of Contrast Transcranial Doppler, Contrast Transthoracic Echocardiography, and Contrast Transesophageal Echocardiography

Yang

Wang

Wei

et al. 2020

BioMed Research International

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Objectives. To access the distinct values of contrast transcranial Doppler (cTCD), contrast transthoracic echocardiography (cTTE), and contrast transesophageal echocardiography (cTEE) in the diagnosis of right-to-left shunt (RLS) due to patent foramen ovale (PFO) and to define the most practical strategy for the diagnosis of PFO. Methods. 102 patients with a high clinical suspicion for PFO had simultaneous cTCD, cTTE, and cTEE performed. The agitated saline mixed with blood was used to detect right-to-left shunt (RLS). Results. In all 102 patients, the shunt was detected at rest by cTCD in 60.78% of cases, by cTTE in 42.16%, and by cTEE in 47.06%. The positive results of all 3 techniques with Valsalva maneuver (VM) were significantly improved. cTCD showed higher pick-up rate than cTTE (98.04% vs. 89.22%; χ2=12.452, p<0.05) and the cTEE (98.04% vs. 96.08%; nonsignificant difference) in the diagnosis of PFO. Nevertheless, cTEE, compared with cTTE, underestimated shunting in 44% of patients. The diameter of both PFO entrance and exit was significantly greater in patients with a severe shunt compared with a mild shunt (2.8±1.0 mm vs. 2.0±0.7 mm, t=3.135, p<0.05; 2.2±0.7 mm vs. 1.6±0.4 mm, t=−2.582, p<0.05). There was a nonsignificant difference in tunnel length between patients with mild shunting and severe shunting(9.3±2.7 mm vs. 9.4±2.9 mm; t=1.358, p>0.05). Conclusions. The best method to diagnose PFO should be the combination of cTCD, cTTE, and cTEE. And cTCD should be applied as the first choice for screening RLS. Then, cTTE should be performed to quantify the severity of the shunt. Last but not least, cTEE should be performed to assess the morphologies of PFO when the closure is planned. The study provides for clinicians the most practical strategy for diagnosing PFO in the future. However, further trials with a large sample size are required to confirm this finding.

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“…Clinical history of migraine with or without aura was defined according to the International Headache Society criteria (17). The PFO-RLS was diagnosed using contrast transesophageal echocardiography (c-TEE) and contrast transesophageal echocardiography (TEE) examination, as described in our previous studies (18,19). The grading of PFO-RLS was defined based on the following criteria: when no, 1-10 bubbles, 11-30 bubbles, and >30 bubbles (or left atrial opacity) were detected, the RLS was considered to be negative, mild, moderate, and extensive, respectively.…”

Section: Participantsmentioning

confidence: 99%

A Nomogram for the Prediction of Cessation of Migraine Among Patients With Patent Foramen Ovale After Percutaneous Closure

2020

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Objective: This study aimed to develop and validate a nomogram to predict cessation of patent foramen ovale (PFO) patients with migraine headache after percutaneous closure. Methods: A total of 247 eligible patients with PFO and migraine after percutaneous closure between May, 2016 and May, 2018 were divided into a development cohort (n = 149) and a validation cohort (n = 98). The primary end point was cessation of migraine at follow-up of 1 year after the procedure measured by the Migraine Disability Assessment Score (MIDAS). In the development cohort, the LASSO regression was used data dimension reduction. A multivariable logistic regression analysis was used to develop the predicting nomogram. The performance of the nomogram was assessed by concordance index (C-index), calibration and clinical usefulness. The results were validated in the validation cohort. Results: Migraine with aura, history of antiplatelet, and the right-to-left shunt (RLS) at rest were identified as significant predictors based on the analysis of multivariate logistic regression. The nomogram incorporating these variables showed good calibration and discrimination in the development cohort with C-index of 0.906 (95% CI: 0.847-0.965), which was confirmed using the validation cohort with C-index of 0.827 (95% CI: 0.751-0.903). The nomogram showed good agreement between prediction by nomogram and actual observation. Furthermore, the decision curve indicated that the novel nomogram was clinically useful. Conclusion: The novel nomogram showed favorable predictive accuracy for cessation of migraine among patients with PFO after percutaneous closure and might provide constructive guidance in clinical decision making.

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

Cited by 14 publications

References 34 publications

Prevalence and grade of RLS in migraine: a prospective study of 251 migraineurs by synchronous test of c-TTE and c-TCD

Prevalence and grade of RLS in migraine: a prospective study of 251 migraineurs by synchronous test of c-TTE and c-TCD

Diagnosis of Patent Foramen Ovale: The Combination of Contrast Transcranial Doppler, Contrast Transthoracic Echocardiography, and Contrast Transesophageal Echocardiography

A Nomogram for the Prediction of Cessation of Migraine Among Patients With Patent Foramen Ovale After Percutaneous Closure

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