Transthoracic contrast echocardiography using vitamin B6 and sodium bicarbonate as contrast agents for the diagnosis of patent foramen ovale.
To evaluate the utility of transthoracic contrast echocardiography (cTTE) using vitamin B6 and sodium bicarbonate as contrast agents for diagnosing right-to-left shunt (RLS) caused by patent foramen ovale (PFO) compared to that of transesophageal echocardiography (TEE). We investigated 125 patients admitted to our neurology department with unexplained cerebral infarction and migraine. All patients underwent cTTE using vitamin B6 and sodium bicarbonate as contrast agents, after which they underwent transthoracic echocardiography. The Doppler signal was recorded during the Valsalva maneuver, and TEE examinations were performed. The feasibility, diagnostic sensitivity, and safety of cTTE and TEE for PFO recognition were compared. Evidence of PFO was found in 49 (39.20%) patients with cTTE, more than were detected with TEE (39, 31.20%) (χ2=5.0625, P=0.0244). cTTE had a sensitivity of 92.31% and a specificity of 84.88% for diagnosing PFO, showing high concordance with TEE for PFO recognition (κ=0.72). Further, results of a semi-quantitative evaluation of PFO-RLS by cTTE were better than those with TEE (Z=-2.011, P=0.044). No significant adverse reaction was discovered during cTTE examination. cTTE using vitamin B6 and sodium bicarbonate as contrast agents has relatively good sensitivity and specificity for diagnosing RLS caused by PFO when compared with those for TEE. Using vitamin B6 and sodium bicarbonate as contrast agents to perform cTTE is recommended for detecting and diagnosing the PFO due to its simplicity, non-invasive character, low cost, and high feasibility.
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Jiang-Chun
JC
He
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Jian-Yong
JY
Zheng
Department of Ultrasound, Navy General Hospital of PLA, Beijing, 100048, China.
Xin
X
Li
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Ye
Y
Yang
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Bo-Yang
BY
Zhang
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Yu
Y
Chen
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Xian-Feng
XF
Li
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Ying-Ming
YM
Liu
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Yi
Y
Cao
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China.
Li
L
Zhao
Department of Cardiology, Navy General Hospital of PLA, Beijing, 100048, China. ltcnavy@163.com.
Tian-Chang
TC
Li
D000293:Adolescent; D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D003326:Coronary Circulation; D018618:Echocardiography, Doppler, Color / Q000009:adverse effects / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D054085:Foramen Ovale / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000503:physiopathology; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D017693:Sodium Bicarbonate / Q000008:administration & dosage* / Q000009:adverse effects; D014636:Valsalva Maneuver; D025101:Vitamin B 6 / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
D003287:Contrast Media; D025101:Vitamin B 6; D017693:Sodium Bicarbonate
Patent foramen ovale; Sodium bicarbonate; Transesophageal echocardiography; Transthoracic contrast echocardiography; Vitamin B6