Harmonic Imaging Improves Sensitivity at the Expense of Specificity in the Detection of Patent Foramen Ovale

Madala, Durga; Zaroff, Jonathan G.; Hourigan, Lisa; Foster, Elyse

doi:10.1111/j.0742-2822.2004.02168.x

Cited by 58 publications

(35 citation statements)

References 17 publications

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“…16 Use of harmonic imaging with TT echocardiography and contrast injection may also increase the sensitivity of PFO detection. 17,18 Saline contrast injection can be performed while imaging the heart with a TE probe. Again, PFO is judged to be present with the visualization of microbubbles in the left atrium within 3 cardiac cycles from the right atrial opacification.…”

Section: Contrast Echocardiographymentioning

confidence: 99%

Patent Foramen Ovale and Stroke

2005

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Section: Contrast Echocardiographymentioning

confidence: 99%

Patent Foramen Ovale and Stroke

2005

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“…We believe that the impact of this phenomenon in this study is limited, and steps were taken to decrease the unmasking of intracardiac shunts as per the methods. Studies investigating the presence of PFO used Valsalva maneuvers and patient positioning to increase right-to-left shunting and to increase the sensitivity of the test, 24 …”

Section: Discussionmentioning

confidence: 99%

Clinical predictors and characteristics of patients with chronic liver disease and intrapulmonary shunts

Santa-Cruz¹,

Pearson²,

Cohen³

et al. 2005

Clin Cardiol

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SummaryBackground: Intrapulmonary shunting (IPS) is a well-described phenomenon in chronic liver disease but its significance is not known.Hypothesis: The study was undertaken to enhance our understanding of the characteristics and prevalence of IPS.Methods: We retrospectively studied 204 consecutive patients with end-stage chronic liver disease who underwent a dobutamine stress echocardiogram, along with a saline contrast bubble study, as part of their pretransplant evaluation.Results: Intrapulmonary shunting of any degree was present in 56.4% of patients. Patients with IPS were more likely to report alcohol use and less likely to have diabetes mellitus. Patients in Child-Pugh classification C were more likely to have IPS than those with classification A or B. The resting room air PaO2 levels were significantly lower in patients with grade 3-4 IPS than in those with grade 1-2. Elevated estimated pulmonary systolic pressure on echocardiography was more prevalent in patients with than in those without IPS.Conclusions: A majority of patients with end-stage chronic liver disease undergoing transplant evaluation have IPS. There are important baseline differences between patients with and without IPS. The presence of IPS is associated with increased severity of chronic liver disease. Further study is required to define the prognostic significance of IPS and its impact on future liver transplantation.

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“…72 However, these differences are probably due to differences in image quality, which is better when images are taken at the second harmonic frequency rather than at the fundamental frequency. 73,74 There is one report in which higher occurrence of IPVD in comparison to findings from other studies [72][73][74][75] was attributed to better resolution of the TTE images at the second harmonic. 76 The sensitivity of TTE for diagnosing IPVD is currently questioned less than its capacity to rule out false-positive results, such as cases of patent foramen ovale.…”

Section: Diagnosing Of Ipvdmentioning

confidence: 92%

Hepatopulmonary syndrome: an update

Macedo

Lopes

2009

Sao Paulo Med. J.

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Hepatopulmonary syndrome (HPS) is a clinical threesome composed of liver disease, intrapulmonary vascular dilatation (IPVD) and arterial gas abnormalities. Its occurrence has been described in up to 32% of cirrhotic candidates for liver transplantation. It also affects non-cirrhotic patients with portal hypertension. Its pathogenesis is not well defined, but an association of factors such as imbalance in the endothelin receptor response, pulmonary microvascular remodeling and genetic predisposition is thought to lead to IPVD. Diagnosis is based on imaging methods that identify these dilatations, such as contrast echocardiography or perfusion scintigraphy with RESUMOA síndrome hepatopulmonar (SHP) é considerada uma tríade clínica composta de doença hepática, dilatações vasculares intrapulmonares (IPVD) e alterações de gases arteriais. Há descrição de sua ocorrência em até 32% dos cirróticos candidatos ao transplante de fígado, acometendo também não cirróticos com hipertensão portal. Sua etiopatogenia não está bem definida, mas se especula que a associação de fatores como o desequilíbrio na resposta dos receptores vasculares de endotelina, o remodelamento microvascular pulmonar e a predisposição genética propiciem as IPVD. O diagnóstico baseia-se em métodos de imagem que identifiquem essas dilatações, como a ecocardiografia com contraste ou a cintilografia de perfusão com 99m Tc, além da análise de gases arteriais, para identificar elevação da diferença alvéolo-arterial de O 2 ou hipoxemia. Não existe tratamento medicamentoso eficaz e sua resolução completa ocorre apenas com o transplante de fígado. A importância do diagnóstico da SHP está em priorizar os candidatos ao transplante, uma vez que sua presença está associada ao pior prognóstico. O objetivo deste artigo é fazer revisão das teorias de etiopatogenia da

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Harmonic Imaging Improves Sensitivity at the Expense of Specificity in the Detection of Patent Foramen Ovale

Abstract: In the detection of PFO, HTTE improves sensitivity at the expense of specificity, particularly if the timing of contrast appearance in the left heart is ignored.

Cited by 58 publications

References 17 publications

Patent Foramen Ovale and Stroke

Patent Foramen Ovale and Stroke

Clinical predictors and characteristics of patients with chronic liver disease and intrapulmonary shunts

Hepatopulmonary syndrome: an update

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