Head-to-head comparison of real-time three-dimensional transthoracic echocardiography with transthoracic and transesophageal two-dimensional contrast echocardiography for the detection of patent foramen ovale.
OBJECTIVE
To assess the incremental value of real-time three-dimensional echocardiography (RT-3DTE) over contrast transthoracic echocardiography (TTE), compared with contrast transesophageal echocardiography (TEE) in the identification of patent foramen ovale (PFO).


RESULTS
Eighty-one consecutive patients with history of migraine headache (MH) or unexplained cerebrovascular events (CE) were examined using RT-3DTE, contrast TTE, and contrast TEE in sequence. Feasibility of RT-3DE in patients with MH and CE was 98 and 91%, respectively. Mean time for 3D colour data set acquisition was 9 +/- 5 min. PFO was diagnosed using contrast TEE in 36 patients (overall prevalence = 44%). Diagnostic accuracy of RT-3DE was significantly higher than that of contrast TTE: sensitivity 83 vs. 44%, P < 0.001; specificity 100 vs. 100%, P7 = NS; positive predictive value 100 vs. 100%, P = NS; negative predictive value 88 vs. 69%, P < 0.01; accuracy 93 vs. 75%, P < 0.003. Five of the six patients in whom RT-3DTE did not identify PFOs showed a defect diameter smaller than 2 mm.


CONCLUSIONS
RT-3DTE is a feasible, accurate, and reproducible technique to detect PFO without the need of saline contrast injection. Its accuracy is superior to contrast 2D TTE and close to that of contrast TEE.
Monte
Ines
I
Clinical Echocardiography, Echo Department, Policlinic of University, via S.Sofia 78-95125, Catania, Italy. inemonte@unict.it
Grasso
Stefania
S
Licciardi
Salvatore
S
Badano
Luigi P
LP
D000328:Adult; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors