Effectiveness of transthoracic echocardiogram in patent foramen ovale diagnosis. Systematic review of last ten years
DOI:
https://doi.org/10.31053/1853.0605.v76.n4.23988Keywords:
transthoracic echocardiography, transesophageal echocardiography, patent foramen ovale, diagnosis.Abstract
Background: Transesophageal echo (TEE) bubble study is the current gold standard for patent foramen ovale (PFO) diagnosis, but it has the disadvantage of being semi-invasive and not exempted from risks. The aim of this study was to determine the accuracy of TTE compared to TEE for PFO diagnosis.
Methods and results: a systematic review was done on Medline with the terms "transthoracic echocardiography, transesophageal echocardiography, patent foramen ovale, diagnosis" yielding published literature of the last ten years. The search was completed in february 2018. Of 715 articles, 10 were analyzed. The total of patients were 1268 (mean age of 47 years +/-14) with a global prevalence of PFO of 48%. The sensibility of ETT was 90 % (IC 95: 88 % - 92 %) and the specificity 92% (IC 95: 89 % - 94 %). The positive predictive value was 93% (IC 95: 90 % - 94 %) and the negative predictive value 89 % (IC 95: 87 % - 91 %). The area under the curve and Q index value were 0,97 and 0,93 respectively. The positive and negative likelihood ratio were 18,989 and 0,072 respectively.
Conclusion: The ETT shows a good specificity and sensibility for PFO diagnosis with last generation equipments, contrast use and valsalva maneuver; according to the analyzed studies.
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References
Hagen PT. Incidence and Size of Patent Foramen Ovale During the First 10 Decades of Life: An Autopsy Study of 965 Normal Hearts. Mayo Clin Proc. 1984;59(1):17-20. doi:10.1016/S0025-6196(12)60336-X.
Godart F, Rey C, Prat A, et al. Atrial right-to-left shunting causing severe hypoxaemia despite normal right-sided pressures Report of 11 consecutive cases corrected by percutaneous closure. 2000:483-489. doi:10.1053/euhj.1999.1944.
Schuchlenz HW, Weihs W, Horner S, Quehenberger F. The Association between the Diameter of a Patent Cerebrovascular Events. Am J Med. 2000;109:456-462.
Khessali H, Mojadidi MK, Gevorgyan R. The Effect of Patent Foramen Ovale Closure on Visual Aura Without Headache or Typical Aura With Migraine Headache. JCIN. 2012;5(6):682-687. doi:10.1016/j.jcin.2012.03.013.
Seiler C. How should we assess patent foramen ovale ? 2004:1245-1247. doi:10.1136/hrt.2003.031500.
Pearson AC, Labovitz AJ, Tatinen S, Gomez CR. Superiority of Transesophageal Echocardiography in Detecting Cardiac Source of Embolism in Patients With Cerebral Ischemia of Uncertain Etiology. 1856;11:66-72. doi:10.1016/0735-1097(91)90705-E.
de Belder MA, Tourikis L, Griffith M, Leech G, Camm AJ. Transesophageal contrast echocardiography and color flow mapping : Methods of choice for the detection of shunts at the atrial level ? Am Hear J. 1992;124:1545.
Lee RJ, Bartzokis T, Yeoh T, Grogin HR, Choi D, Schnittger I. Enhanced Detection of Intracardiac Sources of Cerebral Emboli by Transesophageal Echocardiography. Sroke. 1991;22:734-739.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting: meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008-12
Li Yue, Ya-Nan Z, Li-Qun W. Which technique is better for detection of right-to- Left shunt in patients with patent foramen ovale: Comparing contrast transthoracic echocardiography with contrast transesophageal echocardiography. Echocardiography. 2014;31(9):1050-1055. doi:10.1111/echo.12523.
Lam YY, Yu CM, Zhang Q, Yan BP, Yip GWK. Enhanced detection of patent foramen ovale by systematic transthoracic saline contrast echocardiography. Int J Cardiol. 2011;152(1):24-27. doi:10.1016/j.ijcard.2010.06.018.
Zhao E, Cheng G, Zhang Y, Li Y, Wang Y. Comparison of Different Contrast Agents in Detecting Cardiac Right-to-Left Shunt in Patients with a Patent Foramen Ovale during Contrast-Transthoracic Echocardiography. Biomed Res Int. 2017;2017. doi:10.1155/2017/6086094.
González-Alujas T, Evangelista A, Santamarina E, et al. Diagnóstico y cuantificación del foramen oval permeable. ¿cuál es la técnica de referencia? Estudio simultáneo con Doppler transcraneal, ecocardiografía transtorácica y transesofágica. Rev Esp Cardiol. 2011;64(2):133-139. doi:10.1016/j.recesp.2010.10.009.
Marriott K, Manins V, Forshaw A, Wright J, Pascoe R. Detection of right-to-left atrial communication using agitated saline contrast imaging: Experience with 1162 patients and recommendations for echocardiography. J Am Soc Echocardiogr. 2013;26(1):96-102. doi:10.1016/j.echo.2012.09.007.
Zito C, Dattilo G, Oreto G, et al. Patent foramen ovale: Comparison among diagnostic strategies in cryptogenic stroke and migraine. Echocardiography. 2009;26(5):495-503. doi:10.1111/j.1540-8175.2008.00852.x.
Maffè S, Dellavesa P, Zenone F, et al. Transthoracic second harmonic two- and three-dimensional echocardiography for detection of patent foramen ovale. Eur J Echocardiogr. 2010;11(1):57-63. doi:10.1093/ejechocard/jep165.
Zuber M, Cuculi F, Oechslin E, Erne P, Jenni R. Is transesophageal echocardiography still necessary to exclude patent foramen ovale ? 2008;(January):222-225. doi:10.1080/14017430801932832.
Lefèvre J, Lafitte S, Reant P, Perron J, Roudaut R. Optimization of patent foramen ovale detection by contrast transthoracic echocardiography using. 2008;101:213-219.
Monte I, Grasso S, Licciardi S, Badano LP. Head-to-head comparison of real-time three-dimensional transthoracic echocardiography with transthoracic and transesophageal two-dimensional contrast echocardiography for the detection of patent foramen ovale. Eur J Echocardiogr. 2010;11(3):245-249. doi:10.1093/ejechocard/jep195.
Ovbiagele B, Nguyen-huynh MN. Stroke Epidemiology : Advancing Our Understanding of Disease Mechanism and Therapy. Neurotherapeutics. 2011;8:319-329. doi:10.1007/s13311-011-0053-1.
Bogousslavsky J, Kaste M, Skyhoj T, Werner O. Risk Factors and Stroke Prevention. Cerebrovasc Dis. 2000;10(suppl 3):12-21.
Gorelick PB, Sacco RL, Smith DB, et al. Prevention of a First Stroke. JAMA. 1999;281:1112-1120.
Mas JL, Derumeaux G, Guillon B, et al. new england journal. 2017;377(11):1011-1021. doi:10.1056/NEJMoa1705915.
Crrol JD, Saver JL, Thaler DE, et al. Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke. N Engl J Med. 2013;368(12):1092-1100. doi:10.1056/NEJMoa1301440.
Søndergaard L, Kasner SE, Rhodes JF, et al. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med. 2017;377(11):1033-1042. doi:10.1056/NEJMoa1707404.
Saver JL, Carrol JD, Thaler DE, et al. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med. 2017;377(11):1022-1032. doi:10.1056/NEJMoa1610057.
Kuhl HP, Hoffmann R, Merx MW, et al. Transthoracic Echocardiography Using Second Harmonic Imaging. Am J Cardiol. 1999;34(6):1823-1830. doi:10.1016/S0735-1097(99)00412-X.
Caidahl K, Kazzam E, Lidberg J, et al. Early reports New concept in echocardiography : harmonic imaging of tissue without use of contrast agent. Lancet. 1998;352:1264-1270.
Hilberath JN, Oakes DA, Shernan SK, Bulwer BE, Ambra MND, Eltzschig HK. Safety of Transesophageal Echocardiography. J Am Soc Echocardiogr. 2010;23(11):1115-1127. doi:10.1016/j.echo.2010.08.013.
Mojadidi MK, Winoker JS, Roberts SC, Msaouel P, Gevorgyan R, Zolty R. Two-dimensional echocardiography using second harmonic imaging for the diagnosis of intracardiac right-to-left shunt : a meta-analysis of prospective studies. Int J Cardiovasc Imaging. 2014;30:911-923. doi:10.1007/s10554-014-0426-8.
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