title: Contrast echocardiography for pulmonary arteriovenous malformations screening: does any bubble matter?
abstract: OBJECTIVE
  To evaluate diagnostic accuracy of contrast echocardiography (CE) as compared with CT, for the screening of pulmonary arteriovenous malformations (PAVMs) in hereditary haemorrhagic telangiectasia (HHT); to evaluate the clinical significance of semi-quantitative analysis of a shunt on CE.
  
  
  RESULTS
  A blinded prospective study was conducted in 190 consecutive subjects at risk of HHT who underwent screening for PAVMs, including clinical evaluation, pulse oximetry, standard and CE, and chest multirow CT without contrast medium. A semi-quantitative analysis of the shunt size was performed according to the contrast echo opacification of the left-sided chambers: Grade 0, no bubbles; 1, occasional filling with <20 bubbles; 2, moderate filling; 3, complete opacification. The first 100 patients were compared with 100 controls. A total of 119 (63%) patients had positive CE (32.2% Grade 1, 13.1% Grade 2, 11% Grade 3, 6.3% with patent foramen ovale). The overall diagnostic performance of CE was sensitivity 1.00, specificity 0.49, positive predictive value (PPV) 0.32, negative predictive value (NPV) 1.00. The PPV for the different grades was 0.00 for Grade 1, 0.56 for Grade 2, 1.00 for Grade 3; the NPV of Grade 0 was 1.00. A significant correlation was found between the CE grading and the number of PAVM, and complications (P < 0.0001).
  
  
  CONCLUSIONS
  CE is an extremely sensitive procedure for the detection of PAVMs with substantial clinical impact.
authors.affiliation: Cardiology Department, Maggiore Hospital, Crema, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Gazzaniga
authors.forename: E
authors.initials: E
authors.lastname: Buscarini
authors.forename: G
authors.initials: G
authors.lastname: Leandro
authors.forename: L
authors.initials: L
authors.lastname: Reduzzi
authors.forename: M
authors.initials: M
authors.lastname: Grosso
authors.forename: G
authors.initials: G
authors.lastname: Pongiglione
authors.forename: C
authors.initials: C
authors.lastname: Pedrinazzi
authors.forename: L
authors.initials: L
authors.lastname: Lanzarini
authors.forename: V
authors.initials: V
authors.lastname: Portugalli
authors.forename: P
authors.initials: P
authors.lastname: Blotta
authors.forename: P
authors.initials: P
authors.lastname: Forner
authors.forename: E
authors.initials: E
authors.lastname: Boccardi
authors.forename: F
authors.initials: F
authors.lastname: Pagella
authors.forename: G
authors.initials: G
authors.lastname: Manfredi
authors.forename: C
authors.initials: C
authors.lastname: Olivieri
authors.forename: A
authors.initials: A
authors.lastname: Zambelli
authors.forename: C
authors.initials: C
authors.lastname: Danesino
authors.forename: G
authors.initials: G
authors.lastname: Inama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D004621:Embolization, Therapeutic; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D010092:Oximetry; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult