Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Right-to-left shunt detection via synchronized contrast transcranial Doppler combined with contrast transthoracic echocardiography: A preliminary study
Man-Juan Yao, Ying-Ying Zhao, Shui-Ping Deng, Hua-Hua Xiong, Jing Wang, Li-Jie Ren, Li-Ming Cao
Man-Juan Yao, Li-Jie Ren, Li-Ming Cao, Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
Man-Juan Yao, Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen 518121, Guangdong Province, China
Ying-Ying Zhao, Shui-Ping Deng, Hua-Hua Xiong, Jing Wang, Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
Ying-Ying Zhao, Shui-Ping Deng, Hua-Hua Xiong, Jing Wang, Department of Ultrasound, Shenzhen Second People's Hospital, Shenzhen 518000, Guangdong Province, China
Li-Jie Ren, Department of Neurology, Shenzhen Second People's Hospital, Shenzhen 518000, Guangdong Province, China
Li-Ming Cao, Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410000, Hunan Province, China
Author contributions: Yao MJ and Cao LM drafted the manuscript; Zhao YY, Deng SP, Xiong HH, and Wang J performed the research; Ren LJ and Cao LM conceived the study and made critical revisions. All authors have read and approved the final manuscript.
Supported by The Shenzhen Second People’s Hospital Clinical Research Fund of the Shenzhen High-level Hospital Construction Project, No. 20223357021 and No. 20243357001; Research Project of Teaching Reform in Shenzhen Second People’s Hospital, No. 202209; and Guangdong Province Basic and Applied Basic Research Fund Project, No. 2020B1515120061.
Institutional review board statement: This study was approved by the Ethics Review Board of the First Affiliated Hospital of Shenzhen University (Approval No. 20220413006).
Clinical trial registration statement: This study is an observational research project that, in accordance with international conventions, does not require registration as it does not involve any additional interventions on patients.
Informed consent statement: Written informed consent was obtained from the participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Li-Ming Cao, MD, PhD, Adjunct Associate Professor, Department of Neurology, The First Affiliated Hospital of Shenzhen University, No. 3002 Sungang West Road, Shenzhen 518000, Guangdong Province, China.
caolm-2007@163.com
Received: June 17, 2024
Revised: September 6, 2024
Accepted: September 12, 2024
Published online: November 28, 2024
Processing time: 163 Days and 0.3 Hours
BACKGROUND
Patent foramen ovale (PFO)-related right-to-left shunts (RLSs) have been implicated in cryptogenic stroke and migraine, with larger shunts posing a higher risk. When used individually to detect RLS, contrast transcranial Doppler (cTCD) and contrast transthoracic echocardiography (cTTE) may yield false-negative results. Further, the literature exposes gaps regarding the understanding of the limitations of cTCD and cTTE, presents conflicting recommendations on their exclusive use, and highlights inefficiencies associated with nonsynchronous testing.
AIM
To investigate the accuracy of multimodal ultrasound to improve diagnostic efficiency in detecting PFO-related RLSs.
METHODS
We prospectively enrolled four patients with cryptogenic stroke (n = 1), migraine (n = 2), and unexplained dizziness (n = 1) who underwent synchronized cTCD combined with cTTE. The participants were monitored and followed-up for 24 months.
RESULTS
cTTE identified moderate and large RLSs in patients with recurrent cryptogenic stroke and migraines, whereas cTCD revealed only small RLSs. Moderate and large RLS were confirmed on combined cTTE and cTCD. After excluding other causes, both patients underwent PFO occlusion. At 21- and 24-month follow-up examinations, neither stroke nor migraine had recurred. cTTE revealed a small RLS in a third patient with unexplained dizziness and a fourth patient with migraines; however, simultaneous cTCD detected a large RLS. These patients did not undergo interventional occlusion, and dizziness and headache recurred at the 17- and 24-month follow-up examinations.
CONCLUSION
Using cTTE or cTCD may underestimate RLS, impairing risk assessments. Combining synchronized cTCD with cTTE could enhance testing accuracy and support better diagnostic and therapeutic decisions.
Core Tip: Synchronized multimodal ultrasonography, combining contrast transcranial Doppler (cTCD) with contrast transthoracic echocardiography (cTTE), enhances the accuracy of right-to-left shunt (RLS) detection in patients with cryptogenic stroke, migraine, and dizziness. Traditional methods relying solely on cTCD or cTTE may result in false-negative or underestimated RLS results. Synchronized testing offers a more comprehensive assessment, enabling the identification of inherently large RLS and supporting precise etiological analyses. Incorporating synchronized multimodal ultrasonography into clinical practice can enhance patient outcomes by facilitating more accurate diagnosis and informed treatment decision-making in individuals with cryptogenic stroke, migraine, and dizziness.
