The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke

Lee, Seonhwa; Kim, In Cheol; Nam, Hyo Suk; Kim, So yeon; Choi, Seon Mi; Chang, Hyuk Jae

doi:10.1007/s00330-021-08037-y

Cited by 9 publications

(9 citation statements)

References 33 publications

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“…Nevertheless, the detection rate of a CLA with a contrast jet flow and the diagnostic accuracy of PFO did not differ between patients with and without AF at CT acquisition. A previous study has indicated that a contrast jet flow through the PFO was mostly detected between 60% and 70% of the R-R interval [16], and cardiac CT images in the present study were acquired at similar phases in many subjects. The 60%-70% interval of the cardiac cycle is usually the previous phase of the P wave on ECG; therefore, an atrial contraction could not be a crucial factor for detecting a contrast jet flow via PFO.…”

Section: Discussionmentioning

confidence: 68%

“…In previous studies, a CLA of the IAS and a CLA with a visible jet flow of contrast media in cardiac CT have been described as findings indicative of PFO [15,16]. Kim et al reported that CLA with a jet flow had a higher PPV for PFO diagnosis (90.5%) than a CLA alone (52.6%) [15].…”

Section: Discussionmentioning

confidence: 99%

“…PFO is reported in 20%-25% of the population [1], and in the present study, we were able to obtain a diagnosis rate of PFO of 19%, which was similar to the general prevalence using TEE and catheter crossing into the IAS as reference standards for PFO diagnosis. In several studies, the diagnostic performance of cardiac CT for the detection of PFO was validated using TEE as a gold standard [15,16,22], but no previous study has reported the use of TEE and catheterization as standards.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, the diagnostic sensitivity of a CLA with a jet flow was 65.5%, suggesting that TEE is superior in ruling out PFO in patients suspected of cryptogenic stroke. However, a recent report demonstrated that retrospective ECG-gated cardiac CT throughout the full cardiac cycle can improve the detectability of PFO compared to singlephase cardiac CT [16]. If further studies establish that some imaging acquisition methods increase the diagnostic sensitivity of cardiac CT for the detection of PFO, cardiac CT may be used as an alternative method to TEE for the detection of PFO, particularly in patients with stroke who have difficulty undergoing TEE.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Performance of Cardiac Computed Tomography for Detecting Patent Foramen Ovale: Evaluation Using Transesophageal Echocardiography and Catheterization as Reference Standards

Miki

Nakagawa

Ichikawa

et al. 2023

JCDD

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Background: Patent foramen ovale (PFO) is associated with various diseases such as cryptogenic stroke, migraine, and platypnea–orthodeoxia syndrome. This study aimed to evaluate the diagnostic performance of cardiac computed tomography (CT) for PFO detection. Materials and Methods: Consecutive patients diagnosed with atrial fibrillation and who underwent catheter ablation with pre-procedural cardiac CT and transesophageal echocardiography (TEE) were enrolled in this study. The presence of PFO was defined as (1) the confirmation of PFO using TEE and/or (2) the catheter crossing the interatrial septum (IAS) into the left atrium during ablation. CT findings indicative of PFO included (1) the presence of a channel-like appearance (CLA) on the IAS and (2) a CLA with a contrast jet flow from the left atrium to the right atrium. The diagnostic performance of both a CLA alone and a CLA with a jet flow was evaluated for PFO detection. Results: Altogether, 151 patients were analyzed in the study (mean age, 68 years; men, 62%). Twenty-nine patients (19%) had PFO confirmed by TEE and/or catheterization. The diagnostic performance of a CLA alone was as follows: sensitivity, 72.4%; specificity, 79.5%; positive predictive value (PPV), 45.7%; negative predictive value (NPV), 92.4%. The diagnostic performance of a CLA with a jet flow was as follows: sensitivity, 65.5%; specificity, 98.4%; PPV, 90.5%; NPV, 92.3%. The diagnostic performance of a CLA with a jet flow was statistically superior to that of a CLA alone (p = 0.045), and the C-statistics were 0.76 and 0.82, respectively. Conclusion: A CLA with a contrast jet flow in cardiac CT has a high PPV for PFO detection, and its diagnostic performance is superior to that of a CLA alone.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Performance of Cardiac Computed Tomography for Detecting Patent Foramen Ovale: Evaluation Using Transesophageal Echocardiography and Catheterization as Reference Standards

Miki

Nakagawa

Ichikawa

et al. 2023

JCDD

View full text Add to dashboard Cite

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“…The positive likelihood ratio of 26.5 indicates that patients with PFO had a 26-times higher chance of being CCT positive than that in patients without PFO. Conversely, the negative likelihood ratio of 0.31 indicates that patients are 31% likely to have a PFO if CCT is negative [Lee 2021].…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography for Detecting Patent Foramen Ovale: A Meta-Analysis

Lou

Bao

et al. 2022

HSF

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Objective: Patent foramen ovale (PFO) has been regarded as a potential source of cryptogenic stroke, which was conventionally detected by transesophageal echocardiography. Cardiac computed tomography (CCT) is a promising, noninvasive test for detection of PFO. We sought to conduct a meta-analysis to evaluate the diagnostic performance of CCT in detecting PFO. Methods: PubMed, ISI Web of Knowledge, Embase, Cochrane Library, and Wanfang from inception to June 2020 were searched for relevant studies comparing CCT and transesophageal echocardiography as the reference standard in detecting PFO. A bivariate model was used to pool sensitivity and specificity and to construct summary receiver operating characteristic (SROC) curves. Results: A total of seven studies with 483 patients were included in this meta-analysis. For the diagnosis of PFO, CCT had a mean sensitivity and specificity of 0.70 [95% CI:0.58, 0.79] and 0.97 [95% CI: 0.95, 0.99]. The SROC analysis showed an area under the curve of 0.97. Conclusion: CCT shows good diagnostic accuracy in detecting PFO with relatively high sensitivity and specificity. CCT could be considered a noninvasive alternative to transesophageal echocardiography for detecting PFO.

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Detection of patent foramen ovale in patients with ischemic stroke on prospective ECG-gated cardiac CT compared to transthoracic echocardiography

et al. 2023

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Background Cardiac CT acquired during the acute stroke imaging protocol is an emerging alternative to transthoracic echocardiography (TTE) to screen for sources of cardioembolism. Currently, its diagnostic accuracy to detect patent foramen ovale (PFO) is unclear. Methods This was a substudy of Mind the Heart, a prospective cohort in which consecutive adult patients with acute ischemic stroke underwent prospective ECG-gated cardiac CT during the initial stroke imaging protocol. Patients also underwent TTE. We included patients < 60 years who underwent TTE with agitated saline contrast (cTTE) and assessed sensitivity, specificity, negative and positive predictive value of cardiac CT for the detection of PFO using cTTE as the reference standard. Results Of 452 patients in Mind the Heart, 92 were younger than 60 years. Of these, 59 (64%) patients underwent both cardiac CT and cTTE and were included. Median age was 54 (IQR 49–57) years and 41/59 (70%) were male. Cardiac CT detected a PFO in 5/59 (8%) patients, 3 of which were confirmed on cTTE. cTTE detected a PFO in 12/59 (20%) patients. Sensitivity and specificity of cardiac CT were 25% (95% CI 5–57%) and 96% (95% CI 85–99%), respectively. Positive and negative predictive values were 59% (95% CI 14–95) and 84% (95% CI 71–92). Conclusion Prospective ECG-gated cardiac CT acquired during the acute stroke imaging protocol does not appear to be a suitable screening method for PFO due to its low sensitivity. Our data suggest that if cardiac CT is used as a first-line screening method for cardioembolism, additional echocardiography remains indicated in young patients with cryptogenic stroke, in whom PFO detection would have therapeutic consequences. These results need to be confirmed in larger cohorts.

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The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke

Cited by 9 publications

References 33 publications

Diagnostic Performance of Cardiac Computed Tomography for Detecting Patent Foramen Ovale: Evaluation Using Transesophageal Echocardiography and Catheterization as Reference Standards

Diagnostic Performance of Cardiac Computed Tomography for Detecting Patent Foramen Ovale: Evaluation Using Transesophageal Echocardiography and Catheterization as Reference Standards

Computed Tomography for Detecting Patent Foramen Ovale: A Meta-Analysis

Detection of patent foramen ovale in patients with ischemic stroke on prospective ECG-gated cardiac CT compared to transthoracic echocardiography

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