Comparison of methods for the diagnosis of patent foramen ovale in
patients with cryptogenic cerebral ischemia: a meta-analysis
Abstract
Background: Foramen ovale is a residual cavity in the developing heart
in the fetus. At present, the standard methods for the diagnosis of
PFO-right-to-left-shunting (PFO-RLS) include transesophageal
echocardiography (TEE), contrast-transcranial Doppler echocardiography
(C-TCD), and contrast-transthoracic echocardiography (C-TTE), each of
them having its advantages and disadvantages.However, there are no data
allowing the comparison of these three methods. Methods: We
systematically reviewed all published studies on patients with
cryptogenic cerebral ischemia. The sensitivity, specificity, and other
indexes of C-TCD and C-TTE in the diagnosis of PFO-RLS were calculated
using the Stata 16.0 software. The area under the summary receiver
operating curve(SROC) was calculated. Results: Twenty-five 25
controlled studies involving a total of 2282 patients were analyzed.
There was considerable heterogeneity between C-TCD and C-TTE sensitivity
and specificity among the studies. The combined sensitivity and
specificity of C-TCD and C-TTE were 0.95 (95%CI, 0.93-0.97) and
0.86(95%CI, 0.78-0.91), and 0.88 (95%CI, 0.69-0.96) and 0.99 (95%CI,
0.67-1.00). The positive likelihood ratio and negative likelihood ratio
of C-TCD and C-TTE were 6.81 (95%CI, 4.42-10.48) and 0.05 (95%CI,
0.03-0.08), and 82.31(95%CI, 2.03-3341.00) and 0.12 (95%CI,
0.04-0.34). The areas under the SROC for C-TCD and C-TTE were 0.97
(95%CI, 0.95–0.98) and 0.98 (95%CI, 0.96–0.99), respectively, and
were not significantly different by the Z test (z=-0.17, p=0.86).
Conclusion: C-TCD and C-TTE have advantages in diagnosing PFO-RTL. The
combination of C-TCD and C-TTE improves the detection rate and reduces
the misdiagnosis rate. Key words: patent foramen ovale, cryptogenic
cerebral ischemia, contrast-transthoracic echocardiography,
contrast-transthoracic echocardiography