3,9,10,14 This divergence between c-TCD and echocardiography may be due to the presence of an extracardiac RLS.

3,11–13 Moreover, c-TCD detects up to 30% of RLS cases that are not detected by TEE, whilst RLS cases detected by TEE but not detected by c-TCD are only anecdotal. 7,8 However, c-TCD detects the presence of RLS in a high percentage of patients with ischaemic stroke of undetermined origin, 9,10 and this figure is comparable with that of TEE. 5,6 TEE is considered the “gold standard” for the diagnosis of RLS, especially because it enables direct visualisation of a PFO with more sensitivity and specificity than TTE. 1,2 It can be detected by various techniques, such as contrast-enhanced transcranial Doppler (c-TCD), 3,4 transthoracic echocardiography (TTE) 7,8 and transesophageal echocardiography (TEE). Right-to-left shunt (RLS) occurs when there is a patent foramen ovale (PFO) or extracardiac arteriovenous fistula, and it is a risk factor for cerebral paradoxical embolism. Los estudios clínicos deberían considerar al DTC-c como mejor técnica para diagnosticar CDI cuando se sospecha embolia paradójica. ConclusionesĮl ETT y ETE presentan un número elevado de falsos negativos para detección de CDI, cuando se comparan con el DTC-c. La precisión del ETT y ETE se incrementó cuando se compararon con el DTC-c en reposo. El ETE, comparado con DTC-c tras MV, mostró: sensibilidad 63,4%, especificidad 83,3%, VPP 93%, VPN 39,4% y precisión 67,9%. El ETT, comparado con DTC-c tras MV, mostró: sensibilidad 31,8%, especificidad 96,9%, valor predictivo positivo (VPP) 95,6%, valor predictivo negativo (VPN) 40,5% y precisión 52.9% para detectar CDI. La detección de CDI fue mayor con DTC-c que con ETT (67,6 vs. El ETT se realizó en 102 y el ETE en 81 pacientes. Se incluyeron 115 pacientes a los que se les realizó monitorización con DTC-c. La precisión del ETT y ETE para detectar CDI fue calculada comparándolos con DTC-c. El ETT y ETE se realizaron cuando estaba indicado según el protocolo de estudio cerebrovascular de nuestro centro. Material y métodosĮstudio observacional de pacientes <55 años con isquemia cerebral de origen indeterminado (2007–2009) a los que se les realizó una monitorización con DTC-c para detectar CDI, en reposo y tras maniobra de Valsalva (MV). Objetivo: Evaluar la precisión del ecocardiograma (ETT y ETE) para detectar CDI, comparándolo con DTC-c. Clinical studies should consider the c-TCD as the best technique to diagnose RLS when a paradoxical embolism is suspected.Įl Doppler transcraneal con contraste (DTC-c) tiene una alta sensibilidad para la detección de comunicación derecha-izquierda (CDI), probablemente mayor que la del ecocardiograma transtorácico (ETT) y comparable con la del transesofágico (ETE). TTE and TEE show a considerable number of false negatives for RLS detection. The accuracy of TTE and TEE improved when they were compared with c-TCD at rest. TEE, compared with c-TCD after MV showed: sensitivity 63.4%, specificity 83.3%, PPV 93%, NPV 39.4% and accuracy 67.9%.

The TTE, compared with c-TCD after MV showed: sensitivity 31.8%, specificity 96.9%, positive predictive value (PPV) 95.6%, negative predictive value (NPV) 40.5% and accuracy 52.9% to detect RLS. RLS detection was higher with c-TCD than with TTE (67.6% vs. The TTE was performed in 102, and TEE in 81, patients. ResultsĪ total of 115 patients with c-TCD, mean age 43.3 (SD 10.3) years, 51.3% male. The accuracy of TTE and TEE for detecting RLS was calculated by comparing them with c-TCD. The TTE and TEE were performed when indicated by our cerebrovascular protocol. All underwent c-TCD monitoring to detect RLS, at rest and after Valsalva manoeuvre (VM). Observational study of patients <55 years old with cerebral ischaemia of undetermined origin (2007–2009). To evaluate the accuracy of echocardiography (TTE and TEE) to detect RLS compared to c-TCD. Contrast transcranial Doppler (c-TCD) has a high sensitivity for detecting right-to-left shunt (RLS), and is probably higher than transthoracic echocardiography (TTE) and comparable with transesophageal echocardiography (TEE).

Echo cardiograph