Transcranial Doppler as a Screening Tool for High‐Risk Patent Foramen Ovale in Cryptogenic Stroke
ABSTRACT BACKGROUND AND PURPOSE The identification of high‐risk patent foramen ovale (PFO) is important for selecting suitable patients for PFO closure to prevent recurrent stroke in those with cryptogenic stroke. We aimed to evaluate the predictability of transcranial Doppler (TCD) in diagnosing hi...
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| Veröffentlicht in: | Journal of neuroimaging 2021-01, Vol.31 (1), p.165-170 |
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| creator | Park, Seongho Oh, Jin Kyung Song, Jae‐Kwan Kwon, Boseong Kim, Bum Joon Kim, Jong S. Kang, Dong‐Wha Chang, Jun Young Lee, Ji Sung Kwon, Sun U. |
| description | ABSTRACT
BACKGROUND AND PURPOSE
The identification of high‐risk patent foramen ovale (PFO) is important for selecting suitable patients for PFO closure to prevent recurrent stroke in those with cryptogenic stroke. We aimed to evaluate the predictability of transcranial Doppler (TCD) in diagnosing high‐risk PFO compared with that of transesophageal echocardiography (TEE), which is not feasible for some stroke patients.
METHODS
We retrospectively reviewed the data of 461 cryptogenic stroke patients who underwent TEE and TCD for PFO evaluation. High‐risk PFO on TEE was defined as PFO with atrial septal aneurysm (phasic septal excursion ≥10 mm) or large PFO (≥2 mm). Spencer grading of right‐to‐left shunt was used to classify the amount of shunt on TCD.
RESULTS
PFO on TEE was observed for 242 (52.5%) patients, and high‐risk PFO was detected for 123 (26.7%) patients. However, PFO on TCD was observed for 336 (72.9%) patients. Among patients with significant shunt (Spencer grade III or higher) who underwent TCD after Valsalva maneuver (VM), 60.0% of patients had high‐risk PFO. However, only 5.3% of patients had high‐risk PFO among those without significant shunt. Receiver operating characteristic curves showed that significant shunt after VM had higher predictability (AUC = .876, 95% CI: .843‐.905) for detecting the high‐risk PFO compared with the predictability based on significant shunt at rest (AUC = .718, 95% CI: .674‐.759). (P |
| doi_str_mv | 10.1111/jon.12783 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2440900096</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2479966534</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3533-fdfe75e1db9bace48cbb7fdd372e7162453e457211ebfba28cd03be38e0d95223</originalsourceid><addsrcrecordid>eNp1kMtOwzAQRS0EolBY8APIEhtYpPUjzmOJylsVRbSsI8eZlJTUDnYK6o5P4Bv5EgwtLJCYxcwszr2auQgdUNKjvvozo3uUxQnfQDtUCBZEIko3_U4EDRhLwg7adW5GCKMh49uow1mSRmnEd5CaWKmd8q2SNT4zTVODxdJhicfKAuhKT_HEmBqXxuKravr48fZ-X7knfCdb0C2-MFbOQePRi6wBVxoP7LJpzdQrFR631jzBHtoqZe1gfz276OHifDK4Coajy-vB6TBQXHAelEUJsQBa5GkuFYSJyvO4LAoeM4hpxELBIRQxoxTyMpcsUQXhOfAESJEKxngXHa98G2ueF-DabF45BXUtNZiFy1gYkpQQ4h_voqM_6MwsrPbXeSpO0ygSPPTUyYpS1jhnocwaW82lXWaUZF_Je5XOvpP37OHacZHPofglf6L2QH8FvFY1LP93ym5GtyvLT_53jho</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2479966534</pqid></control><display><type>article</type><title>Transcranial Doppler as a Screening Tool for High‐Risk Patent Foramen Ovale in Cryptogenic Stroke</title><source>Wiley Online Library All Journals</source><creator>Park, Seongho ; Oh, Jin Kyung ; Song, Jae‐Kwan ; Kwon, Boseong ; Kim, Bum Joon ; Kim, Jong S. ; Kang, Dong‐Wha ; Chang, Jun Young ; Lee, Ji Sung ; Kwon, Sun U.</creator><creatorcontrib>Park, Seongho ; Oh, Jin Kyung ; Song, Jae‐Kwan ; Kwon, Boseong ; Kim, Bum Joon ; Kim, Jong S. ; Kang, Dong‐Wha ; Chang, Jun Young ; Lee, Ji Sung ; Kwon, Sun U.</creatorcontrib><description>ABSTRACT
BACKGROUND AND PURPOSE
The identification of high‐risk patent foramen ovale (PFO) is important for selecting suitable patients for PFO closure to prevent recurrent stroke in those with cryptogenic stroke. We aimed to evaluate the predictability of transcranial Doppler (TCD) in diagnosing high‐risk PFO compared with that of transesophageal echocardiography (TEE), which is not feasible for some stroke patients.
METHODS
We retrospectively reviewed the data of 461 cryptogenic stroke patients who underwent TEE and TCD for PFO evaluation. High‐risk PFO on TEE was defined as PFO with atrial septal aneurysm (phasic septal excursion ≥10 mm) or large PFO (≥2 mm). Spencer grading of right‐to‐left shunt was used to classify the amount of shunt on TCD.
RESULTS
PFO on TEE was observed for 242 (52.5%) patients, and high‐risk PFO was detected for 123 (26.7%) patients. However, PFO on TCD was observed for 336 (72.9%) patients. Among patients with significant shunt (Spencer grade III or higher) who underwent TCD after Valsalva maneuver (VM), 60.0% of patients had high‐risk PFO. However, only 5.3% of patients had high‐risk PFO among those without significant shunt. Receiver operating characteristic curves showed that significant shunt after VM had higher predictability (AUC = .876, 95% CI: .843‐.905) for detecting the high‐risk PFO compared with the predictability based on significant shunt at rest (AUC = .718, 95% CI: .674‐.759). (P<.0001 for the differences between two AUCs).
CONCLUSIONS
TCD is a good screening tool for evaluating high‐risk PFO. VM is important for the evaluation of PFO. Patients with minimal or no shunt on TCD after VM are unlikely to have high‐risk PFO.</description><identifier>ISSN: 1051-2284</identifier><identifier>EISSN: 1552-6569</identifier><identifier>DOI: 10.1111/jon.12783</identifier><identifier>PMID: 32896963</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>cryptogenic stroke ; Echocardiography ; Evaluation ; Neuroimaging ; Patent foramen ovale ; Risk assessment ; Stroke ; transesophageal echocardiography ; trasncranial Doppler ; Ultrasound</subject><ispartof>Journal of neuroimaging, 2021-01, Vol.31 (1), p.165-170</ispartof><rights>2020 American Society of Neuroimaging</rights><rights>2020 American Society of Neuroimaging.</rights><rights>2021 American Society of Neuroimaging</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3533-fdfe75e1db9bace48cbb7fdd372e7162453e457211ebfba28cd03be38e0d95223</citedby><cites>FETCH-LOGICAL-c3533-fdfe75e1db9bace48cbb7fdd372e7162453e457211ebfba28cd03be38e0d95223</cites><orcidid>0000-0002-0504-2539</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjon.12783$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjon.12783$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32896963$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Park, Seongho</creatorcontrib><creatorcontrib>Oh, Jin Kyung</creatorcontrib><creatorcontrib>Song, Jae‐Kwan</creatorcontrib><creatorcontrib>Kwon, Boseong</creatorcontrib><creatorcontrib>Kim, Bum Joon</creatorcontrib><creatorcontrib>Kim, Jong S.</creatorcontrib><creatorcontrib>Kang, Dong‐Wha</creatorcontrib><creatorcontrib>Chang, Jun Young</creatorcontrib><creatorcontrib>Lee, Ji Sung</creatorcontrib><creatorcontrib>Kwon, Sun U.</creatorcontrib><title>Transcranial Doppler as a Screening Tool for High‐Risk Patent Foramen Ovale in Cryptogenic Stroke</title><title>Journal of neuroimaging</title><addtitle>J Neuroimaging</addtitle><description>ABSTRACT
BACKGROUND AND PURPOSE
The identification of high‐risk patent foramen ovale (PFO) is important for selecting suitable patients for PFO closure to prevent recurrent stroke in those with cryptogenic stroke. We aimed to evaluate the predictability of transcranial Doppler (TCD) in diagnosing high‐risk PFO compared with that of transesophageal echocardiography (TEE), which is not feasible for some stroke patients.
METHODS
We retrospectively reviewed the data of 461 cryptogenic stroke patients who underwent TEE and TCD for PFO evaluation. High‐risk PFO on TEE was defined as PFO with atrial septal aneurysm (phasic septal excursion ≥10 mm) or large PFO (≥2 mm). Spencer grading of right‐to‐left shunt was used to classify the amount of shunt on TCD.
RESULTS
PFO on TEE was observed for 242 (52.5%) patients, and high‐risk PFO was detected for 123 (26.7%) patients. However, PFO on TCD was observed for 336 (72.9%) patients. Among patients with significant shunt (Spencer grade III or higher) who underwent TCD after Valsalva maneuver (VM), 60.0% of patients had high‐risk PFO. However, only 5.3% of patients had high‐risk PFO among those without significant shunt. Receiver operating characteristic curves showed that significant shunt after VM had higher predictability (AUC = .876, 95% CI: .843‐.905) for detecting the high‐risk PFO compared with the predictability based on significant shunt at rest (AUC = .718, 95% CI: .674‐.759). (P<.0001 for the differences between two AUCs).
CONCLUSIONS
TCD is a good screening tool for evaluating high‐risk PFO. VM is important for the evaluation of PFO. Patients with minimal or no shunt on TCD after VM are unlikely to have high‐risk PFO.</description><subject>cryptogenic stroke</subject><subject>Echocardiography</subject><subject>Evaluation</subject><subject>Neuroimaging</subject><subject>Patent foramen ovale</subject><subject>Risk assessment</subject><subject>Stroke</subject><subject>transesophageal echocardiography</subject><subject>trasncranial Doppler</subject><subject>Ultrasound</subject><issn>1051-2284</issn><issn>1552-6569</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kMtOwzAQRS0EolBY8APIEhtYpPUjzmOJylsVRbSsI8eZlJTUDnYK6o5P4Bv5EgwtLJCYxcwszr2auQgdUNKjvvozo3uUxQnfQDtUCBZEIko3_U4EDRhLwg7adW5GCKMh49uow1mSRmnEd5CaWKmd8q2SNT4zTVODxdJhicfKAuhKT_HEmBqXxuKravr48fZ-X7knfCdb0C2-MFbOQePRi6wBVxoP7LJpzdQrFR631jzBHtoqZe1gfz276OHifDK4Coajy-vB6TBQXHAelEUJsQBa5GkuFYSJyvO4LAoeM4hpxELBIRQxoxTyMpcsUQXhOfAESJEKxngXHa98G2ueF-DabF45BXUtNZiFy1gYkpQQ4h_voqM_6MwsrPbXeSpO0ygSPPTUyYpS1jhnocwaW82lXWaUZF_Je5XOvpP37OHacZHPofglf6L2QH8FvFY1LP93ym5GtyvLT_53jho</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Park, Seongho</creator><creator>Oh, Jin Kyung</creator><creator>Song, Jae‐Kwan</creator><creator>Kwon, Boseong</creator><creator>Kim, Bum Joon</creator><creator>Kim, Jong S.</creator><creator>Kang, Dong‐Wha</creator><creator>Chang, Jun Young</creator><creator>Lee, Ji Sung</creator><creator>Kwon, Sun U.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7QP</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0504-2539</orcidid></search><sort><creationdate>202101</creationdate><title>Transcranial Doppler as a Screening Tool for High‐Risk Patent Foramen Ovale in Cryptogenic Stroke</title><author>Park, Seongho ; Oh, Jin Kyung ; Song, Jae‐Kwan ; Kwon, Boseong ; Kim, Bum Joon ; Kim, Jong S. ; Kang, Dong‐Wha ; Chang, Jun Young ; Lee, Ji Sung ; Kwon, Sun U.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3533-fdfe75e1db9bace48cbb7fdd372e7162453e457211ebfba28cd03be38e0d95223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>cryptogenic stroke</topic><topic>Echocardiography</topic><topic>Evaluation</topic><topic>Neuroimaging</topic><topic>Patent foramen ovale</topic><topic>Risk assessment</topic><topic>Stroke</topic><topic>transesophageal echocardiography</topic><topic>trasncranial Doppler</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Park, Seongho</creatorcontrib><creatorcontrib>Oh, Jin Kyung</creatorcontrib><creatorcontrib>Song, Jae‐Kwan</creatorcontrib><creatorcontrib>Kwon, Boseong</creatorcontrib><creatorcontrib>Kim, Bum Joon</creatorcontrib><creatorcontrib>Kim, Jong S.</creatorcontrib><creatorcontrib>Kang, Dong‐Wha</creatorcontrib><creatorcontrib>Chang, Jun Young</creatorcontrib><creatorcontrib>Lee, Ji Sung</creatorcontrib><creatorcontrib>Kwon, Sun U.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neuroimaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, Seongho</au><au>Oh, Jin Kyung</au><au>Song, Jae‐Kwan</au><au>Kwon, Boseong</au><au>Kim, Bum Joon</au><au>Kim, Jong S.</au><au>Kang, Dong‐Wha</au><au>Chang, Jun Young</au><au>Lee, Ji Sung</au><au>Kwon, Sun U.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transcranial Doppler as a Screening Tool for High‐Risk Patent Foramen Ovale in Cryptogenic Stroke</atitle><jtitle>Journal of neuroimaging</jtitle><addtitle>J Neuroimaging</addtitle><date>2021-01</date><risdate>2021</risdate><volume>31</volume><issue>1</issue><spage>165</spage><epage>170</epage><pages>165-170</pages><issn>1051-2284</issn><eissn>1552-6569</eissn><abstract>ABSTRACT
BACKGROUND AND PURPOSE
The identification of high‐risk patent foramen ovale (PFO) is important for selecting suitable patients for PFO closure to prevent recurrent stroke in those with cryptogenic stroke. We aimed to evaluate the predictability of transcranial Doppler (TCD) in diagnosing high‐risk PFO compared with that of transesophageal echocardiography (TEE), which is not feasible for some stroke patients.
METHODS
We retrospectively reviewed the data of 461 cryptogenic stroke patients who underwent TEE and TCD for PFO evaluation. High‐risk PFO on TEE was defined as PFO with atrial septal aneurysm (phasic septal excursion ≥10 mm) or large PFO (≥2 mm). Spencer grading of right‐to‐left shunt was used to classify the amount of shunt on TCD.
RESULTS
PFO on TEE was observed for 242 (52.5%) patients, and high‐risk PFO was detected for 123 (26.7%) patients. However, PFO on TCD was observed for 336 (72.9%) patients. Among patients with significant shunt (Spencer grade III or higher) who underwent TCD after Valsalva maneuver (VM), 60.0% of patients had high‐risk PFO. However, only 5.3% of patients had high‐risk PFO among those without significant shunt. Receiver operating characteristic curves showed that significant shunt after VM had higher predictability (AUC = .876, 95% CI: .843‐.905) for detecting the high‐risk PFO compared with the predictability based on significant shunt at rest (AUC = .718, 95% CI: .674‐.759). (P<.0001 for the differences between two AUCs).
CONCLUSIONS
TCD is a good screening tool for evaluating high‐risk PFO. VM is important for the evaluation of PFO. Patients with minimal or no shunt on TCD after VM are unlikely to have high‐risk PFO.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32896963</pmid><doi>10.1111/jon.12783</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-0504-2539</orcidid></addata></record> |
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| subjects | cryptogenic stroke Echocardiography Evaluation Neuroimaging Patent foramen ovale Risk assessment Stroke transesophageal echocardiography trasncranial Doppler Ultrasound |
| title | Transcranial Doppler as a Screening Tool for High‐Risk Patent Foramen Ovale in Cryptogenic Stroke |
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