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The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke

  • Cardiac
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Abstract

Objectives

We explored the hypothesis that the diagnostic performance of cardiac computed tomography (CT) throughout the full cardiac cycle would be superior to single-phase CT and comparable to transesophageal echocardiography (TEE) in diagnosing patent foramen ovale (PFO).

Methods and results

From May 2011 to April 2015, 978 patients with stroke were diagnosed with PFO by TEE. In patients with stroke, cardiac CT was performed if the patients had more than two cardiovascular risk factors. We prospectively enrolled 70 patients with an indication for cardiac CT. Cardiac CT images were reconstructed at 10% increments of the R-R interval. The sensitivity of cardiac CT throughout the full cardiac cycle in diagnosing PFO was compared to that for TEE and single-phase cardiac CT. To evaluate the specificity of cardiac CT, we analyzed patients without PFO confirmed by TEE who underwent cardiac CT within 1 month of pre-cardiac surgery. Sixty-six patients with cardiac CT and TEE were included in the final analysis. Throughout the full cardiac cycle, cardiac CT had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing PFO, compared to TEE as a reference. PFO was primarily detected in the 60% and 70% intervals in 10-phase reconstructed images. The sensitivity of PFO diagnosis with cardiac CT was 81.8% when analyzing both the 60% and 70% intervals instead of the full cardiac cycle.

Conclusion

Cardiac CT throughout the full cardiac cycle outperforms single-phase cardiac CT in detecting PFO. Cardiac CT can be used as an alternative method to TEE for detecting PFO in stroke patients.

Key Points

• Throughout the full cardiac cycle, cardiac computed tomography (CT) had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing patent foramen ovale (PFO), compared to transesophageal echocardiography.

• The sensitivity of diagnosing patent foramen ovale with cardiac CT was 81.8% when analyzing 60% and 70% R-R intervals instead of the full cardiac cycle.

• Cardiac CT with retrospective electrocardiographic gating throughout the full cardiac cycle can increase the detectability of PFO, compared to single-phase cardiac CT.

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Abbreviations

CAOD:

Coronary artery occlusive disease

CT:

Computed tomography

ECG:

Electrocardiography

IAS:

Interatrial septum

LA:

Left atrium

LAVI:

Left atrial volume index

NPV:

Negative predictive value

PFO:

Patent foramen ovale

PPV:

Positive predictive value

RA:

Right atrium

TEE:

Transesophageal echocardiography

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Funding

This study has received funding by the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, Republic of Korea, the Ministry of Food and Drug Safety) (Project Number: 202016B02).

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Seonhwa Lee & Hyuk-Jae Chang

  2. Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea

    In-Cheol Kim

  3. Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Young Dae Kim & Hyo Suk Nam

  4. CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea

    So yeon Kim & Seon mi Choi

Authors
  1. Seonhwa Lee
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  2. In-Cheol Kim
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  3. Young Dae Kim
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  4. Hyo Suk Nam
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  5. So yeon Kim
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  7. Hyuk-Jae Chang
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Correspondence to Hyuk-Jae Chang.

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Guarantor

The scientific guarantor of this publication is Dr. Chang Hyuk-Jae.

Conflict of Interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

Informed Consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Experimental

• Performed at one institution

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Lee, S., Kim, IC., Kim, Y.D. et al. The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke. Eur Radiol 31, 8983–8990 (2021). https://doi.org/10.1007/s00330-021-08037-y

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  • DOI: https://doi.org/10.1007/s00330-021-08037-y

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