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Two-dimensional echocardiography using second harmonic imaging for the diagnosis of intracardiac right-to-left shunt: a meta-analysis of prospective studies

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Abstract

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 being considered for transcatheter closure. While transesophageal echo (TEE) bubble study is the current standard reference for diagnosing PFO, transthoracic echo with second harmonic imaging (TTE-HI) may be a preferable screening test for RLS due to its high accuracy and non-invasiveness. The aim of this meta-analysis was to determine the accuracy of TTE-HI compared to TEE as the reference. A systematic review of Medline, Cochrane and Embase was done for all the prospective studies assessing for intracardiac RLS using TTE-HI compared to TEE as the reference; both TTE-HI and TEE were performed with a contrast agent and a maneuver to provoke RLS in all studies. A total of 15 studies with 1995 patients fulfilled the inclusion criteria. The weighted mean sensitivity and specificity for TTE-HI were 91 and 93 % respectively. Likewise, the positive and negative likelihood ratios were 13.52 and 0.13 respectively. TTE-HI is a reliable, non-invasive test with proficient diagnostic accuracies. The high sensitivity and specificity of TTE-HI make it a useful initial screening test for RLS. If the precise anatomy is required, then TEE can be obtained before scheduling a patient for transcatheter PFO closure.

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Abbreviations

RLS:

Right-to-left shunt

PFO:

Patent foramen ovale

TTE:

Transthoracic echocardiogram

TTE-HI:

Transthoracic echocardiogram with harmonic imaging

TEE:

Transesophageal echocardiogram

QUADAS:

Quality assessment of diagnostic accuracy studies

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Conflict of interest

All authors have nothing to disclose. No funding from any companies was provided to perform this meta-analysis.

Author information

Authors and Affiliations

  1. Department of Medicine, Montefiore Medical Center and Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 1, Rm 3N1, Bronx, NY, USA

    Mohammad Khalid Mojadidi, Jared S. Winoker, Scott C. Roberts, Pavlos Msaouel & Ronald Zolty

  2. Program in Interventional Cardiology, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

    Rubine Gevorgyan

Authors
  1. Mohammad Khalid Mojadidi
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  2. Jared S. Winoker
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  3. Scott C. Roberts
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  4. Pavlos Msaouel
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  5. Rubine Gevorgyan
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  6. Ronald Zolty
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Corresponding author

Correspondence to Mohammad Khalid Mojadidi.

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Mojadidi, M.K., Winoker, J.S., Roberts, S.C. et al. Two-dimensional echocardiography using second harmonic imaging for the diagnosis of intracardiac right-to-left shunt: a meta-analysis of prospective studies. Int J Cardiovasc Imaging 30, 911–923 (2014). https://doi.org/10.1007/s10554-014-0426-8

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  • DOI: https://doi.org/10.1007/s10554-014-0426-8

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