Key result
Cardiac CT showing a channel-like appearance with contrast jet flow was superior to a channel-like appearance alone for detecting patent foramen ovale (C-statistic 0.82 vs 0.76; p=0.045).
Why the study?
PFO is associated with diseases such as cryptogenic stroke, migraine, and platypnea-orthodeoxia syndrome, but the diagnostic performance of cardiac CT for detecting PFO required evaluation.
Does cardiac CT accurately detect patent foramen ovale compared to TEE and catheterization in patients with atrial fibrillation?
Cross-Sectional (n=151)
Does cardiac CT accurately detect patent foramen ovale compared to TEE and catheterization in patients with atrial fibrillation?
p-value: p=0.045
Cardiac CT demonstrating a channel-like appearance with contrast jet flow provides high positive predictive value and specificity for detecting patent foramen ovale.
Background: Patent foramen ovale (PFO) is associated with various diseases such as cryptogenic stroke, migraine, and platypnea–orthodeoxia syndrome. This study aimed to evaluate the diagnostic performance of cardiac computed tomography (CT) for PFO detection. Materials and Methods: Consecutive patients diagnosed with atrial fibrillation and who underwent catheter ablation with pre-procedural cardiac CT and transesophageal echocardiography (TEE) were enrolled in this study. The presence of PFO was defined as (1) the confirmation of PFO using TEE and/or (2) the catheter crossing the interatrial septum (IAS) into the left atrium during ablation. CT findings indicative of PFO included (1) the presence of a channel-like appearance (CLA) on the IAS and (2) a CLA with a contrast jet flow from the left atrium to the right atrium. The diagnostic performance of both a CLA alone and a CLA with a jet flow was evaluated for PFO detection. Results: Altogether, 151 patients were analyzed in the study (mean age, 68 years; men, 62%). Twenty-nine patients (19%) had PFO confirmed by TEE and/or catheterization. The diagnostic performance of a CLA alone was as follows: sensitivity, 72.4%; specificity, 79.5%; positive predictive value (PPV), 45.7%; negative predictive value (NPV), 92.4%. The diagnostic performance of a CLA with a jet flow was as follows: sensitivity, 65.5%; specificity, 98.4%; PPV, 90.5%; NPV, 92.3%. The diagnostic performance of a CLA with a jet flow was statistically superior to that of a CLA alone (p = 0.045), and the C-statistics were 0.76 and 0.82, respectively. Conclusion: A CLA with a contrast jet flow in cardiac CT has a high PPV for PFO detection, and its diagnostic performance is superior to that of a CLA alone.
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Miki et al. (2023) conducted a cross-sectional in Patent foramen ovale in patients with atrial fibrillation (n=151). Cardiac computed tomography (CLA with contrast jet flow) vs. Cardiac computed tomography (CLA alone) was evaluated on Diagnostic performance for PFO detection (p=0.045). Cardiac CT showing a channel-like appearance with contrast jet flow was superior to a channel-like appearance alone for detecting patent foramen ovale (C-statistic 0.82 vs 0.76; p=0.045).
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