Comparative evaluation of intracardiac, transesophageal, and transthoracic echocardiography in the assessment of patent foramen ovale: A retrospective single‐center study
Introduction Certain patent foramen ovale (PFO) characteristics, such as a large right‐to‐left shunt (RLS) or atrial septal aneurysm, identify patients who may receive the highest clinical benefit from percutaneous PFO closure. This study aimed to compare intracardiac echocardiography (ICE) with sta...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2023-12, Vol.102 (7), p.1348-1356 |
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| creator | Chaturvedi, Abhishek Moroni, Francesco Axline, Michael Tomdio, Anna Mojadidi, Mohammad K. Gertz, Zachary |
| description | Introduction
Certain patent foramen ovale (PFO) characteristics, such as a large right‐to‐left shunt (RLS) or atrial septal aneurysm, identify patients who may receive the highest clinical benefit from percutaneous PFO closure. This study aimed to compare intracardiac echocardiography (ICE) with standard echocardiographic imaging in the evaluation of high‐risk PFO characteristics and RLS severity in patients with PFO‐associated stroke.
Methods
We conducted a retrospective review of all patients aged ≥18 years who underwent percutaneous PFO closure for PFO‐associated stroke and received all three ultrasound‐based cardiac imaging modalities and had interpretable results (N = 51). We then compared RLS severity, high‐risk PFO characteristics, and the proportion of patients with a higher likelihood of PFO‐associated stroke by ICE versus transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE).
Results
The final cohort had a mean (±SE) age of 48.4 (±1.8) years and was predominantly female (58.8%). ICE was more likely to identify a large RLS versus TTE/TEE combined (66.7% vs. 45.1%; p = 0.03). The use of ICE resulted in significantly more patients being reclassified as having a higher likelihood of PFO‐associated stroke (TTE vs. TEE vs. ICE: 10.4% vs. 14.6% vs. 25%; p = 0.03). A high‐quality bubble study was found to be the single most important factor associated with identifying a larger RLS across all modalities (ρ [p]; TTE: 0.49 [ |
| doi_str_mv | 10.1002/ccd.30825 |
| format | Article |
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Certain patent foramen ovale (PFO) characteristics, such as a large right‐to‐left shunt (RLS) or atrial septal aneurysm, identify patients who may receive the highest clinical benefit from percutaneous PFO closure. This study aimed to compare intracardiac echocardiography (ICE) with standard echocardiographic imaging in the evaluation of high‐risk PFO characteristics and RLS severity in patients with PFO‐associated stroke.
Methods
We conducted a retrospective review of all patients aged ≥18 years who underwent percutaneous PFO closure for PFO‐associated stroke and received all three ultrasound‐based cardiac imaging modalities and had interpretable results (N = 51). We then compared RLS severity, high‐risk PFO characteristics, and the proportion of patients with a higher likelihood of PFO‐associated stroke by ICE versus transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE).
Results
The final cohort had a mean (±SE) age of 48.4 (±1.8) years and was predominantly female (58.8%). ICE was more likely to identify a large RLS versus TTE/TEE combined (66.7% vs. 45.1%; p = 0.03). The use of ICE resulted in significantly more patients being reclassified as having a higher likelihood of PFO‐associated stroke (TTE vs. TEE vs. ICE: 10.4% vs. 14.6% vs. 25%; p = 0.03). A high‐quality bubble study was found to be the single most important factor associated with identifying a larger RLS across all modalities (ρ [p]; TTE: 0.49 [<0.001], TEE: 0.60 [<0.001], ICE: 0.32 [0.02]). The presence of a hypermobile septum was associated with significantly greater RLS on ICE (ρ [p]: 0.3 [0.03]), especially with poor quality bubble studies (ρ [p]: 0.49 [0.02]).
Conclusion
In this observational study of patients with PFO‐associated stroke, ICE detected a large RLS more frequently than TTE and TEE; and reclassified some patients as having a higher likelihood of PFO‐associated stroke.
Key Points
Intracardiac echocardiogram (ICE) may provide additional confidence in identifying large right–left shunts.
ICE may help identify patients at higher likelihood of patent foramen ovale‐associated stroke.
High‐quality bubble study is the most important factor associated with large shunts.
There is a strong correlation between hypermobile septum and shunt severity on ICE.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.30825</identifier><identifier>PMID: 37681474</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Adult ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Foramen Ovale, Patent - complications ; Foramen Ovale, Patent - diagnostic imaging ; Foramen Ovale, Patent - therapy ; Humans ; hypermobile septum ; intracardiac echocardiogram ; Male ; Middle Aged ; patent foramen ovale ; PFO‐associated stroke ; Retrospective Studies ; right‐to‐left shunt ; Stroke ; Stroke - etiology ; Treatment Outcome ; Ultrasonic imaging</subject><ispartof>Catheterization and cardiovascular interventions, 2023-12, Vol.102 (7), p.1348-1356</ispartof><rights>2023 The Authors. published by Wiley Periodicals LLC.</rights><rights>2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3885-50b90b2a80fece247f525cdbcacd4cb83f585827b116e21b6d9f705bc87a949c3</citedby><cites>FETCH-LOGICAL-c3885-50b90b2a80fece247f525cdbcacd4cb83f585827b116e21b6d9f705bc87a949c3</cites><orcidid>0000-0003-0241-2845 ; 0000-0002-4574-4287 ; 0000-0002-9613-5246 ; 0000-0002-6101-1403</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.30825$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.30825$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37681474$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chaturvedi, Abhishek</creatorcontrib><creatorcontrib>Moroni, Francesco</creatorcontrib><creatorcontrib>Axline, Michael</creatorcontrib><creatorcontrib>Tomdio, Anna</creatorcontrib><creatorcontrib>Mojadidi, Mohammad K.</creatorcontrib><creatorcontrib>Gertz, Zachary</creatorcontrib><title>Comparative evaluation of intracardiac, transesophageal, and transthoracic echocardiography in the assessment of patent foramen ovale: A retrospective single‐center study</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Introduction
Certain patent foramen ovale (PFO) characteristics, such as a large right‐to‐left shunt (RLS) or atrial septal aneurysm, identify patients who may receive the highest clinical benefit from percutaneous PFO closure. This study aimed to compare intracardiac echocardiography (ICE) with standard echocardiographic imaging in the evaluation of high‐risk PFO characteristics and RLS severity in patients with PFO‐associated stroke.
Methods
We conducted a retrospective review of all patients aged ≥18 years who underwent percutaneous PFO closure for PFO‐associated stroke and received all three ultrasound‐based cardiac imaging modalities and had interpretable results (N = 51). We then compared RLS severity, high‐risk PFO characteristics, and the proportion of patients with a higher likelihood of PFO‐associated stroke by ICE versus transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE).
Results
The final cohort had a mean (±SE) age of 48.4 (±1.8) years and was predominantly female (58.8%). ICE was more likely to identify a large RLS versus TTE/TEE combined (66.7% vs. 45.1%; p = 0.03). The use of ICE resulted in significantly more patients being reclassified as having a higher likelihood of PFO‐associated stroke (TTE vs. TEE vs. ICE: 10.4% vs. 14.6% vs. 25%; p = 0.03). A high‐quality bubble study was found to be the single most important factor associated with identifying a larger RLS across all modalities (ρ [p]; TTE: 0.49 [<0.001], TEE: 0.60 [<0.001], ICE: 0.32 [0.02]). The presence of a hypermobile septum was associated with significantly greater RLS on ICE (ρ [p]: 0.3 [0.03]), especially with poor quality bubble studies (ρ [p]: 0.49 [0.02]).
Conclusion
In this observational study of patients with PFO‐associated stroke, ICE detected a large RLS more frequently than TTE and TEE; and reclassified some patients as having a higher likelihood of PFO‐associated stroke.
Key Points
Intracardiac echocardiogram (ICE) may provide additional confidence in identifying large right–left shunts.
ICE may help identify patients at higher likelihood of patent foramen ovale‐associated stroke.
High‐quality bubble study is the most important factor associated with large shunts.
There is a strong correlation between hypermobile septum and shunt severity on ICE.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Echocardiography</subject><subject>Echocardiography, Transesophageal</subject><subject>Female</subject><subject>Foramen Ovale, Patent - complications</subject><subject>Foramen Ovale, Patent - diagnostic imaging</subject><subject>Foramen Ovale, Patent - therapy</subject><subject>Humans</subject><subject>hypermobile septum</subject><subject>intracardiac echocardiogram</subject><subject>Male</subject><subject>Middle Aged</subject><subject>patent foramen ovale</subject><subject>PFO‐associated stroke</subject><subject>Retrospective Studies</subject><subject>right‐to‐left shunt</subject><subject>Stroke</subject><subject>Stroke - etiology</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc9u1DAQxi0EoqVw4AWQJS4gdVvbiROHW5XyT6rEBSRu1mQy2aRK4mAnRXvjEfogPBVPgnezcEDiNJ9Gv_lm7I-x51JcSCHUJWJ9kQij9AN2KrVSm1xlXx8etSzS7IQ9CeFWCFFkqnjMTpI8MzLN01P2s3TDBB7m7o443UG_ROlG7hrejbMHBF93gOc86jFQcFMLW4L-nMNYr825dZHrkBO27sC7rYep3UUHPrfEIcTBMNA4720nmPeqiUOxxV3cSW_4Ffc0excmwsMpoRu3Pf36cY8RJs_DvNS7p-xRA32gZ8d6xr68e_u5_LC5-fT-Y3l1s8HEGL3RoipEpcCIhpBUmjdaaawrBKxTrEzSaKONyispM1KyyuqiyYWu0ORQpAUmZ-zV6jt5922hMNuhC0h9DyO5JVhlsiQRwmRpRF_-g966xY_xOquK-N95KpSI1OuVwvjE4Kmxk-8G8Dsrhd1HaGOE9hBhZF8cHZdqoPov-SezCFyuwPeup93_nWxZXq-WvwFi1KrY</recordid><startdate>20231201</startdate><enddate>20231201</enddate><creator>Chaturvedi, Abhishek</creator><creator>Moroni, Francesco</creator><creator>Axline, Michael</creator><creator>Tomdio, Anna</creator><creator>Mojadidi, Mohammad K.</creator><creator>Gertz, Zachary</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0241-2845</orcidid><orcidid>https://orcid.org/0000-0002-4574-4287</orcidid><orcidid>https://orcid.org/0000-0002-9613-5246</orcidid><orcidid>https://orcid.org/0000-0002-6101-1403</orcidid></search><sort><creationdate>20231201</creationdate><title>Comparative evaluation of intracardiac, transesophageal, and transthoracic echocardiography in the assessment of patent foramen ovale: A retrospective single‐center study</title><author>Chaturvedi, Abhishek ; Moroni, Francesco ; Axline, Michael ; Tomdio, Anna ; Mojadidi, Mohammad K. ; Gertz, Zachary</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3885-50b90b2a80fece247f525cdbcacd4cb83f585827b116e21b6d9f705bc87a949c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Echocardiography</topic><topic>Echocardiography, Transesophageal</topic><topic>Female</topic><topic>Foramen Ovale, Patent - complications</topic><topic>Foramen Ovale, Patent - diagnostic imaging</topic><topic>Foramen Ovale, Patent - therapy</topic><topic>Humans</topic><topic>hypermobile septum</topic><topic>intracardiac echocardiogram</topic><topic>Male</topic><topic>Middle Aged</topic><topic>patent foramen ovale</topic><topic>PFO‐associated stroke</topic><topic>Retrospective Studies</topic><topic>right‐to‐left shunt</topic><topic>Stroke</topic><topic>Stroke - etiology</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chaturvedi, Abhishek</creatorcontrib><creatorcontrib>Moroni, Francesco</creatorcontrib><creatorcontrib>Axline, Michael</creatorcontrib><creatorcontrib>Tomdio, Anna</creatorcontrib><creatorcontrib>Mojadidi, Mohammad K.</creatorcontrib><creatorcontrib>Gertz, Zachary</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chaturvedi, Abhishek</au><au>Moroni, Francesco</au><au>Axline, Michael</au><au>Tomdio, Anna</au><au>Mojadidi, Mohammad K.</au><au>Gertz, Zachary</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative evaluation of intracardiac, transesophageal, and transthoracic echocardiography in the assessment of patent foramen ovale: A retrospective single‐center study</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2023-12-01</date><risdate>2023</risdate><volume>102</volume><issue>7</issue><spage>1348</spage><epage>1356</epage><pages>1348-1356</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Introduction
Certain patent foramen ovale (PFO) characteristics, such as a large right‐to‐left shunt (RLS) or atrial septal aneurysm, identify patients who may receive the highest clinical benefit from percutaneous PFO closure. This study aimed to compare intracardiac echocardiography (ICE) with standard echocardiographic imaging in the evaluation of high‐risk PFO characteristics and RLS severity in patients with PFO‐associated stroke.
Methods
We conducted a retrospective review of all patients aged ≥18 years who underwent percutaneous PFO closure for PFO‐associated stroke and received all three ultrasound‐based cardiac imaging modalities and had interpretable results (N = 51). We then compared RLS severity, high‐risk PFO characteristics, and the proportion of patients with a higher likelihood of PFO‐associated stroke by ICE versus transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE).
Results
The final cohort had a mean (±SE) age of 48.4 (±1.8) years and was predominantly female (58.8%). ICE was more likely to identify a large RLS versus TTE/TEE combined (66.7% vs. 45.1%; p = 0.03). The use of ICE resulted in significantly more patients being reclassified as having a higher likelihood of PFO‐associated stroke (TTE vs. TEE vs. ICE: 10.4% vs. 14.6% vs. 25%; p = 0.03). A high‐quality bubble study was found to be the single most important factor associated with identifying a larger RLS across all modalities (ρ [p]; TTE: 0.49 [<0.001], TEE: 0.60 [<0.001], ICE: 0.32 [0.02]). The presence of a hypermobile septum was associated with significantly greater RLS on ICE (ρ [p]: 0.3 [0.03]), especially with poor quality bubble studies (ρ [p]: 0.49 [0.02]).
Conclusion
In this observational study of patients with PFO‐associated stroke, ICE detected a large RLS more frequently than TTE and TEE; and reclassified some patients as having a higher likelihood of PFO‐associated stroke.
Key Points
Intracardiac echocardiogram (ICE) may provide additional confidence in identifying large right–left shunts.
ICE may help identify patients at higher likelihood of patent foramen ovale‐associated stroke.
High‐quality bubble study is the most important factor associated with large shunts.
There is a strong correlation between hypermobile septum and shunt severity on ICE.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37681474</pmid><doi>10.1002/ccd.30825</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0241-2845</orcidid><orcidid>https://orcid.org/0000-0002-4574-4287</orcidid><orcidid>https://orcid.org/0000-0002-9613-5246</orcidid><orcidid>https://orcid.org/0000-0002-6101-1403</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Adolescent Adult Echocardiography Echocardiography, Transesophageal Female Foramen Ovale, Patent - complications Foramen Ovale, Patent - diagnostic imaging Foramen Ovale, Patent - therapy Humans hypermobile septum intracardiac echocardiogram Male Middle Aged patent foramen ovale PFO‐associated stroke Retrospective Studies right‐to‐left shunt Stroke Stroke - etiology Treatment Outcome Ultrasonic imaging |
| title | Comparative evaluation of intracardiac, transesophageal, and transthoracic echocardiography in the assessment of patent foramen ovale: A retrospective single‐center study |
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