Biomedical Science Letters (대한의생명과학회지)

The Korean Society for Biomedical Laboratory Sciences (대한의생명과학회)
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Prevalence of Patent Foramen Ovale and Diagnostic Efficacy of Transcranial Doppler Sonography in Cryptogenic Ischemic Stroke Patients

  • Kim, Dae-Sik (Department of Clinical Laboratory Science, Dongnam Health College) ;
  • Kim, Byung-Weon (Department of Clinical Laboratory Science, Gimcheon College) ;
  • Cho, Sung-Jun (Department of Neurology, Seoul National University Bundang Hospital)
  • Published : 2009.03.31
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Abstract

The prevalence of patent foramen ovale (PFO) in healthy persons was estimated as about $10{\sim}25%$ and was up to 40% in patients with stroke. Transesophageal echocardiography (TEE) was considered to be the most sensitive method to detect PFO and was used as the gold standard. Transcranial doppler sonography (TCD) of the middle cerebral artery (MCA) during a contrast (saline bubble) injection has recently been proposed as an alternative detecting method for PFO. In this study, we would like to know the difference between TCD value and TEE value in subjects with cryptogenic ischemic stroke. We performed TCD and TEE tests to detect PFO on 64 patients (30 women and 34 men, mean age was 59.4 years) with cryptogenic ischemic stroke. PFO prevalence through TCD was 45.3% (29 of 64 patients) and the prevalence through TEE was 34.4% (22 of 64 patients). There was no statistical significance between PFO test and TCD test (P=0.206). But TCD had a sensitivity of 90.9% (20 of 22 patients), specificity of 78.6% (33 of 42 patients), positive predictive value of 69.0% (20 of 29 patients), and negative predictive value of 94.3% (33 of 35 patients). We concluded that TCD was a highly sensitive method for detecting a right-left shunt. Therefore, the non-invasive TCD test is a method more effective than the anti-invasive TEE test in the cost and evaluation of the existence or nonexistence of right to left shunt in addition to the screening method of the cerebrovascular disorder. Considering these points, TCD test could be recommended for patients with cryptogenic ischemic stroke as a useful and convenient method for screening of the existence or nonexistence of a right to left shunt caused by PFO.

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References

  1. Anzola G, Morandi E, Casilli F, Onorato E. Does transcatheter closure of Patent Foramen Ovale really "shunt the door-" A prospective study with transcranial Doppler. Stroke 2004. 35: 2140-2144. https://doi.org/10.1161/01.STR.0000137764.07815.de
  2. Bogousslavsky J, Garazi S, Jeanrenaud X, Aebischer N, Van Melle G, for the Lausanne Stroke with Paradoxical Embolism Study Group. Stroke recurrence in patients with patent foramen ovale: The Lausanne Study. Neurology 1996. 46: 1301-1305. https://doi.org/10.1212/WNL.46.5.1301
  3. Chang DI, Lee MS, Cho SH, Bu SH, Chung SH, Huh SH, Yoon KU, Ahn TB, Yoon SS, Chung KC. Incidence of Patent Foramen Ovale in ischemic Stroke Patients: A Transcranial Doppler Study. Korea Neurol Assoc. 2005. 23: 313-317.
  4. Di Tullio M, Sacco RL, Venketasubramanian N, Sherman D, Mohr JP, Homma S. Comparison of diagnostic techniques for the detection of patent foramen ovale in stroke patients. 1993. Stroke 24: 1020-1024. https://doi.org/10.1161/01.STR.24.7.1020
  5. Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale duringthe fir 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984. 59: 17-20.
  6. Jauss M, Zanette E. Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler ultrasound. Cerebrovasc Dis. 2000. 10: 490-496. https://doi.org/10.1159/000016119
  7. Jones HR JF, Caplan LR, Come PC, Swinton NW Jr, Breslin DJ. Cerebral emboli of paradoxical origin. Ann Neurol. 1983. 13: 314. https://doi.org/10.1002/ana.410130315
  8. Klotzsch C, Janssen G, Berlit P. Transesophageal echocardiography and contrast-TCD in the detection of a patent foramen ovale: experiences with 111 patients. Neurology 1994. 44: 1603 -1606. https://doi.org/10.1212/WNL.44.9.1603
  9. Konstadt SN, Louie EK, Black S, Rao TLK, Scanlon P. Intraoperative detection of patent foramen ovale by transesophageal echocardiography. Anesthesiology 1991. 74: 212-216. https://doi.org/10.1097/00000542-199102000-00003
  10. Kronik G, Mosslacher H. Positive contrast echocardiography in patients with patent foramen ovale and normal right heart hemodynamics. Am J Cardiol. 1982. 49: 1806. https://doi.org/10.1016/0002-9149(82)90263-6
  11. Lechat PH, Mas JL, Lascault G, Loron P, Theard M, Klimczac M, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1998. 318: 1148-1152.
  12. Lee MY, Jeon DS, Cheon SS, Lee GH, Gang DH, Kim CM, Chae JS, Park IS, Hong SJ, Choi KB. Frequency of Patent Foramen Ovale and Its Clinical Significance. Korean J Med. 1994. 47: 179-180.
  13. Lynch JJ, Schuchard GH, Gross CM, Wann LS. Prevalence of right-to-left artial shunting in a healthy population; detection by Valsalva maneuver contrast echocardiography. Am J Cardiol. 1984. 53: 1478-1480. https://doi.org/10.1016/S0002-9149(84)91617-5
  14. Michaela M, Steiner MM, Di Tullio MR, Rundek T, Gan R, Chen X, Liguori C, Brainin M, Homma S, Sacco RL. Patent Foramen Ovale Size and Embolic Brain Imaging Findings Among Patients With Ischemic Stroke. Stroke 1998. 29: 944-948. https://doi.org/10.1161/01.STR.29.5.944
  15. Onorato E, Melzi G, Casillli F, Pedon L, Rigatelli G, Carroza A, Maiolino P, Zanchetta M, Morandi E, Angeli S, Anzola GP. Patent Foramen Ovale with paradoxical embolism; mid-term results of transcatheter closure in 256 patient. J Interv Cardiol. 2003. 16: 43-50. https://doi.org/10.1046/j.1540-8183.2003.08002.x
  16. Rodgers DM, Singhh S, Meister SG. Contrast echocardiographic documentation of paradoxical embolism. Am Geart J. 1984. 107: 1270.
  17. Sacco RL, Homma S, Di Tullio MR. Patent foramen ovale: a new risk factor for stroke. Heart Dis Stroke 1993. 2: 235-241.
  18. Seward JB, Khanderia BK, Oh JK, Abel MD, Huges RW, Edward WDM, Nichols BA, Freeman WK, Tajik AJ. Transesophageal echocardiography: Technique, anatomic correlations, implementation, and clinical appications. Mayo Clin Pro. 1988. 63: 649. https://doi.org/10.1016/S0025-6196(12)65529-3
  19. Silva MT, Rodrigues R, Tress I, Victer R, Charmie F. Patent Foramen Ovale in a cohort of young patients with cryptogenic ischemic stroke. Arq Neuropsiquiatr. 2005. 63: 427-429. https://doi.org/10.1590/S0004-282X2005000300012
  20. Siostrzonek P, Zangeneh M, Gossinger H, Lang W, Rosenmayr G, Heinz G, Stumpflen A, Zeiler K, Schwarz M, Mosslacher H. Comparison of transesophageal and transthoracic contrast echocardiography of detection of a Patent Foramen Ovale. Am J Cardiol. 1991. 68: 1247-1249. https://doi.org/10.1016/0002-9149(91)90206-Z
  21. Teague SM, Sharma MK. Detection of paradoxical cerebral echocontrast embolization by transcranial Doppler ultrasound. Stroke 1991. 22: 740-745. https://doi.org/10.1161/01.STR.22.6.740