- 作者：M. Khalid Mojadidi ; MD&lowast ; ; mkmojadidi@gmail.com" class="auth_mail ; Scott C. Roberts ; BS&lowast ; ; Jared S. Winoker ; BS&lowast ; ; Jorge Romero ; MD&lowast ; ; David Goodman-Meza ; MD&lowast ; ; Rubine Gevorgyan ; MD&dagger ; ; Jonathan M. Tobis ; MD&dagger ;
- 关键词：patent foramen ovale ; right-to-left shunt ; transcranial Doppler
- 刊名：JACC: Cardiovascular Imaging
- 出版年：March, 2014
- 年：2014
- 卷：7
- 期：3
- 页码：236-250
- 全文大小：1017 K
Objectives
The aim of this meta-analysis was to determine the accuracy of transcranial Doppler (TCD) compared with transesophageal echocardiography (TEE) as the reference.Background
Right-to-left shunting (RLS), usually through a patent foramen ovale (PFO), has been associated with migraine, cryptogenic stroke, and hypoxemia. With emerging observational studies and clinical trials on the subject of PFO, there is a need for accurate diagnosis of PFO in patients with these conditions, and those being considered for transcatheter closure. Although a TEE bubble study is the current standard reference for diagnosing PFO, the TCD bubble study may be a preferable alternative test for RLS because of its high sensitivity and specificity, noninvasive nature, and low cost.
Methods
A systematic review of Medline, the Cochrane Library, and Embase was done to look for all the prospective studies assessing intracardiac RLS using TCD compared with TEE as the reference; both tests were performed with a contrast agent and a maneuver to provoke RLS in all studies.
Results
A total of 27 studies (29 comparisons) with 1,968 patients (mean age 47.8 卤 5.7 years; 51% male) fulfilled the inclusion criteria. The weighted mean sensitivity and specificity for TCD were 97% and 93%, respectively. Likewise, the positive and negative likelihood ratios were 13.51 and 0.04, respectively. When 10 microbubbles was used as the embolic cutoff for a positive TCD study, TCD produced a higher specificity compared with when 1 microbubble was used as the cutoff (p聽= 0.04); there was, however, no significant change in sensitivity (p聽= 0.29).
Conclusions
TCD is a reliable, noninvasive test with excellent diagnostic accuracies, making it a proficient test for detecting RLS. TCD can be used as a part of the stroke workup and for patients being considered for PFO closure. If knowledge of the precise anatomy is required, then TEE can be obtained before scheduling a patient for transcatheter PFO closure.