Abstract
Aim: The aim of the pilot study was to assess correlation between three diagnostic methods - contrast transesophageal echocardiography (cTEE), contrast transcranial Doppler (cTCD) and Flow detection system AnazenTM (FDS) - in detecting right-to-left shunts in young patients aged under 55 years with ischemic stroke or transient ischemic attack (TIA). Patients and methods: All consecutive patients presenting with acute ischemic stroke or TIA aged 18-55 years and able to perform sufficient Valsalva maneuver who signed informed consent were enrolled to the study from 8/2014 to 4/2015.
Brain-computed tomography or magnetic resonance imaging as well as detection of right-to-left shunt using the cTEE, cTCD and FDS were performed in all patients after an onset of stroke/TIA. Correlations of the results between the methods and sensitivity, specificity, positive and negative predictive values of cTCD and FDS compared to cTEE as a gold standard were statistically evaluated.
Results: In total, 30 patients (21 males, mean age 46.2 +- 8.5 years) were included in the study. Right-to-left shunt was detected in the same eight (26.7%) patients using the cTEE and cTCD, and in one additional patient (totally nine, 30.0%) using FDS.
Spearman's coefficient for cTEE and FDS was 0.92 and for cTEE and cTCD 1.00. Interclass correlation coefficient was 0.975.
Sensitivity, specificity, positive and negative predictive values were 100%, 100%, 100%, 100%, respectively, for cTCD and 100%, 95.5%, 88.9%, 100%, respectively, for FDS. Conclusion: Correlation between cTCD and FDS as a new method with cTEE as a gold standard in right-to-left shunt detection appear to be high.
Considering the ease of their use, both cTCD and FDS appear as suitable screening methods.