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Transesophageal echocardiography and transcranial color Doppler: independent or complementary diagnostic tests for cardiologists in the detection of patent foramen ovale?

Mangiafico, Sarah; Scandura, Salvatore; Ussia, Gian Paolo; Privitera, Agata; Capodanno, Davide; Petralia, Anna; Tamburino, Corrado

Journal of Cardiovascular Medicine: February 2009 - Volume 10 - Issue 2 - p 143–148
doi: 10.2459/JCM.0b013e32831fb210
Original articles
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Background and purpose Contrast-enhanced transesophageal echocardiography (c-TEE) is considered the gold standard for the diagnosis of patent foramen ovale. The purpose of this study was to compare the practical use of contrast-enhanced transcranial color Doppler (c-TCD) to define its role in the diagnostic pathway of patent foramen ovale.

Methods Two hundred and eighty-six consecutive patients with a presumed paradoxical cerebrovascular event were investigated by both c-TEE and c-TCD for the detection of patent foramen ovale. Considering c-TEE as the gold standard for statistical comparison, the sensitivity, specificity, positive predictive value, negative predictive value and global diagnostic accuracy of c-TCD were assessed.

Results Among the entire cohort of patients (286), 156 (54%) showed positive and 116 (41%) negative findings with both the examinations; 10 patients (3%) had a negative result with c-TCD and a positive one with c-TEE; four (1%) had a positive result with c-TCD and a negative one with c-TEE. Thus, for c-TCD, we defined a sensitivity of 94% (95% confidence limits 90–98) and a specificity of 97% (94–100). The positive predictive value for the detection of the shunt was 98% (95% confidence limit 96–100) and the negative predictive value was 92% (95% confidence limit 87–97). Global diagnostic accuracy was 95% (95% confidence limit 92–98). The two examinations showed a strong statistical correlation (r = 0.90; R2 = 0.81; P < 0.001).

Conclusion c-TDC results in an effective, safe and low cost examination, with excellent sensitivity and specificity as compared with c-TEE.

Department of Internal Medicine and Systemic Disease, Clinical Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy

Received 28 February, 2008

Revised 19 September, 2008

Accepted 28 October, 2008

Correspondence to Davide Capodanno, MD, Via Citelli 6, 95124, Catania, Italy Tel: +39 095 7436201; fax: +39 095 362429; e-mail: dcapodanno@gmail.com

© 2009 Italian Federation of Cardiology. All rights reserved.