Diagnosis and Quantification of Patent Foramen Ovale. Which Is the Reference Technique? Simultaneous Study With Transcranial Doppler, Transthoracic and Transesophageal Echocardiography

González‐Alujas, Teresa; Evangelista, Artur; Santamarina, Estevo; Rubiera, Marta; Gómez-Bosch, Zamira; Rodríguez-Palomares, José F.; Avegliano, Gustavo; Molina, Carlos A.; Álvarez-Sabín, José; Garcı́a-Dorado, David

doi:10.1016/j.rec.2010.10.014

Cited by 48 publications

(60 citation statements)

References 38 publications

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“…As previously documented [20,28] we demonstrate moderate agreement between c-TCD and TEE for identifying and grading RLSh. While prior work has suggested that TCD may be a sensitive tool compared to TEE [17,29–33], these prior studies were not performed on large numbers of patients with CS and there is no prior work showing that TCD might be better at distinguishing pathogenically important from less important PFOs.…”

Section: Discussionsupporting

confidence: 84%

The RoPE Score and Right-to-Left Shunt Severity by Transcranial Doppler in the CODICIA Study

Wessler

Kent²,

Thaler

et al. 2015

Cerebrovasc Dis

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Background: For patients with cryptogenic stroke (CS) and patent foramen ovale (PFO), it is unknown whether the magnitude of right-to-left shunt (RLSh) measured by contrast transcranial Doppler (c-TCD) is correlated with the likelihood an identified PFO is related to CS as determined by the Risk of Paradoxical Embolism (RoPE) score. Additionally, for patients with CS, it is unknown whether PFO assessment by c-TCD is more sensitive for identifying RLSh compared with transesophageal echocardiography (TEE). Our aim was to determine the significance of RLSh grade by c-TCD in patients with PFO and CS. Methods: We evaluated patients with CS who had RLSh quantified by c-TCD in the Multicenter Study into RLSh in Cryptogenic Stroke (CODICIA) to determine whether there is an association between c-TCD shunt grade and the RoPE Score. For patients who underwent c-TCD and TEE, we determined whether there is agreement in identifying and grading RLSh between these two modalities. Results: The RoPE score predicted the presence versus the absence of RLSh documented by c-TCD (c-statistic = 0.66). For patients with documented RLSh by c-TCD, shunt severity was correlated with increasing RoPE score (rank correlation (r) = 0.15, p = 0.01). Among 293 patients who had both c-TCD and TEE performed, c-TCD was more sensitive (98.7%) for detecting RLSh. Of the 97 patients with no PFO identified on TEE, 28 (29%) had a large amount of RLSh seen on c-TCD. Conclusions: For patients with CS, severity of RLSh by c-TCD is positively correlated with the RoPE score, indicating that this technique for shunt grading identifies patients more likely to have pathogenic rather than incidental PFOs. c-TCD is also more sensitive in detecting RLSh than TEE. These findings suggest an important role for c-TCD in the evaluation of PFO in the setting of CS.

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Section: Discussionsupporting

confidence: 84%

The RoPE Score and Right-to-Left Shunt Severity by Transcranial Doppler in the CODICIA Study

Wessler

Kent²,

Thaler

et al. 2015

Cerebrovasc Dis

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“…As previously described by González-Alujas et al, 8 a bolus of agitated saline solution was injected via an antecubital vein to induce sufficient filling of RA. After three consecutive cardiac cycles following the Valsalva maneuver, the shunt was evaluated and quantified.…”

Section: Detection Of Patent Foramen Ovalementioning

confidence: 99%

Atrial dyssynchrony and left atrial stiffness are risk markers for cryptogenic stroke in patients with patent foramen ovale

et al. 2017

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“…If doubt remains, agitated saline contrast may be used to confirm the presence of a shunt; in sedated patients, the equivalent of a Valsalva manoeuvre can be achieved by increasing the intra-abdominal pressure with gentle pressure over the upper abdomen, or a patient can be asked to sniff or cough if compliant. False-negative diagnosis may occur if adequate atrial pressure reversal is not achieved 52. TOE is the gold standard for assessment of an ASD in adults.…”

Section: Cardiac Source Of Embolismmentioning

confidence: 99%

Transoesophageal echocardiography: what the general cardiologist needs to know

Wamil

Newton

Rana

et al. 2016

Heart

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Diagnosis and Quantification of Patent Foramen Ovale. Which Is the Reference Technique? Simultaneous Study With Transcranial Doppler, Transthoracic and Transesophageal Echocardiography

Cited by 48 publications

References 38 publications

The RoPE Score and Right-to-Left Shunt Severity by Transcranial Doppler in the CODICIA Study

The RoPE Score and Right-to-Left Shunt Severity by Transcranial Doppler in the CODICIA Study

Atrial dyssynchrony and left atrial stiffness are risk markers for cryptogenic stroke in patients with patent foramen ovale

Transoesophageal echocardiography: what the general cardiologist needs to know

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