ArticleFrontiers in neurology
Bubble-test for detection of a patent foramen ovale in young to middle-aged ischemic stroke patients.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Current stroke guidelines do not recommend routine screening for a patent foramen ovale (PFO) in patients with acute ischemic stroke (AIS) of undetermined cause. This study evaluated the diagnostic accuracy of the transcranial Doppler bubble test (TCD-bubble) for PFO detection in younger AIS patients. Patients and methods: Data from a prospective institutional stroke registry were retrospectively analyzed, including AIS patients aged ≤65 years treated with intravenous thrombolysis (IVT) and/or endovascular therapy (EVT) over 5 years. Right-to-left shunt (RLS) was assessed using the TCD-bubble test. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for PFO detection were calculated using transesophageal echocardiography (TEE) as the reference. Furthermore, we included a ROC-analysis to provide a bubble-threshold and calculated a new sensitivity, specificity, PPV and NPV. Results: Of 383 patients, 120 (31%) underwent TCD-bubble testing: 61 (50.8%) had no RLS, 20 (16.7%) had RLS only during the Valsalva maneuver, and 39 (32.5%) had RLS at rest. Cardiovascular risk profiles and functional outcomes did not differ between RLS-positive and -negative patients. Among 87 patients with TEE, PFO was confirmed in 69.4% of RLS-positive cases (PPV), while a negative TCD-bubble test excluded PFO in 97.4% (NPV). Sensitivity and specificity were 97.1 and 71.2%, respectively. A cut-off of ≥3 bubbles in TCD-bubble testing resulted in a sensitivity of 91.4% and specificity of 88.5% for PFO detection. Conclusion: The TCD-bubble test is a reliable, non-invasive screening tool for PFO in younger AIS patients with high sensitivity and NPV for PFO detection. A positive result warrants confirmatory TEE, while a negative test may preclude further invasive evaluation.
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