Key result
Synchronous multimode ultrasound detects higher rates of grade II and III RLS than cTCD alone.
Why the study?
Right-to-left shunt (RLS) is associated with morbidity, and the effectiveness of synchronous multimode ultrasonography in detecting RLS needed evaluation.
Does synchronous multimode ultrasound improve the detection rate and grading accuracy of right-to-left shunt compared to cTCD alone in patients with high clinical suspicion?
Observational (n=423)
Does synchronous multimode ultrasound improve the detection rate and grading accuracy of right-to-left shunt compared to cTCD alone in patients with high clinical suspicion?
Synchronous multimodal ultrasound combining cTCD and cTTE improves the detection rate and accurate quantification of right-to-left shunts compared to cTCD alone.
Background: Right-to-left shunt (RLS) is associated with several conditions and causes morbidity. In this study, we aimed to evaluate the effectiveness of synchronous multimode ultrasonography in detecting RLS. Methods: We prospectively enrolled 423 patients with high clinical suspicion of RLS and divided them into the contrast transcranial Doppler (cTCD) group and synchronous multimode ultrasound group, in which both cTCD and contrast transthoracic echocardiography (cTTE) were performed during the same process of contrast-enhanced ultrasound imaging. The simultaneous test results were compared with those of cTCD alone. Results: The positive rates of grade II (22.0%:10.0%) and III (12.7%:10.8%) shunts and the total positive rate (82.1748%) in the synchronous multimode ultrasound group were higher than those in the cTCD alone group. Among patients with RLS grade I in the synchronous multimode ultrasound group, 23 had RLS grade I in cTCD but grade 0 in synchronous cTTE, whereas four had grade I in cTCD but grade 0 in synchronous cTTE. Among patients with RLS grade II in the synchronous multimode ultrasound group, 28 had RLS grade I in cTCD but grade II in synchronous cTTE. Among patients with RLS grade III in the synchronous multimode ultrasound group, four had RLS grade I in cTCD but grade III in synchronous cTTE. Synchronous multimode ultrasound had a sensitivity of 87.5% and specificity of 60.6% in the patent foramen ovale (PFO) diagnosis. Binary logistic regression analyses showed that age (odds ratio [OR] = 1.041) and risk of paradoxical embolism score ≥ 7 (OR = 7.798) were risk factors for stroke recurrence, whereas antiplatelets (OR = 0.590) and PFO closure with antiplatelets (OR = 0.109) were protective factors. Conclusion: Synchronous multimodal ultrasound significantly improves the detection rate and test efficiency, quantifies RLS more accurately, and reduces testing risks and medical costs. We conclude that synchronous multimodal ultrasound has significant potential for clinical applications.
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Yao et al. (2023) conducted an observational in Right-to-left shunt (n=423). Synchronous multimode ultrasound vs. Contrast transcranial Doppler (cTCD) alone was evaluated on Detection of right-to-left shunt. Synchronous multimode ultrasound detected higher rates of grade II (22.0% vs 10.0%) and grade III (12.7% vs 10.8%) right-to-left shunts compared to contrast transcranial Doppler alone.
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