Detection of Right-to-left Shunt in Young Patients after Ischemic Stroke – a Pilot Study

Authors: M. Kuliha 1,2;  M. Roubec 1;  A. Goldírová 1,3;  E. Hurtíková 1;  J. Krajča 4;  V. Procházka 4;  M. Kolek 5;  R. Herzig 6;  D. Školoudík 1–3
Authors‘ workplace: Neurologická klinika LF OU a FN Ostrava 1;  Neurologická klinika 1. LF UK a VFN v Praze 2;  Ústav ošetřovatelství, FZV UP v Olomouci 3;  Radiologický ústav, FN Ostrava 4;  Kardiochirurgické centrum, FN Ostrava 5;  Komplexní cerebrovaskulární centrum, Neurologická klinika LF UK a FN Hradec Králové 6
Published in: Cesk Slov Neurol N 2016; 79/112(5): 541-545
Category: Original Paper
doi: 10.14735/amcsnn2016541


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.

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.

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.

Key words:
stroke – right-to-left shunt – patent foramen ovale

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


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