Authors
Aristeidis H. Katsanos
Theodora Psaltopoulou
Theodoros N. Sergentanis
Alexandra Frogoudaki
Agathi Rosa Vrettou
Ignatios Ikonomidis
Ioannis Paraskevaidis
John T. Parissis
Chrysa Bogiatzi
Christina Zompola
John Ellul
Nikos Triantafyllou
Konstantinos Voumvourakis
Athanassios P. Kyritsis
Sotirios Giannopoulos
Anne Alexandrov, Australian Catholic UniversityFollow
Andrei V. Alexandrov
Georgios Tsivgoulis
Publication Date
2016
Publication Details
Katsanos, A. H, Psaltopoulou, T., Sergentanis, T. N, Frogoudaki, A., Vrettou, A. R, Ikonomidis, I., Paraskevaidis, I., Parissis, J. T, Bogiatzi, C., Zompola, C., Ellul, J., Triantafyllou, N., Voumvourakis, K., Kyritsis, A. P, Giannopoulos, S., Alexandrov, A., Alexandrov, A. V & Tsivgoulis, G. (2016). Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia: A systematic review and diagnostic test accuracy meta-analysis. Annals of Neurology, Retrieved from https://doi.org/10.1002/ana.24609
Abstract
Objective Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic ischemic stroke or transient ischemic attack has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. Methods We performed a systematic literature review to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD, or both compared to the gold standard of TEE. Results Our literature search identified 35 eligible studies including 3,067 patients. The pooled sensitivity and specificity for TCD was 96.1% (95% confidence interval [CI] = 93.0–97.8%) and 92.4% (95% CI = 85.5–96.1%), whereas the respective measures for TTE were 45.1% (95% CI = 30.8–60.3%) and 99.6% (95% CI = 96.5–99.9%). TTE was superior in terms of higher positive likelihood ratio values (LR+ = 106.61, 95% CI = 15.09–753.30 for TTE vs LR+ = 12.62, 95% CI = 6.52–24.43 for TCD; p = 0.043), whereas TCD demonstrated lower negative likelihood values (LR− = 0.04, 95% CI = 0.02–0.08) compared to TTE (LR− = 0.55, 95% CI = 0.42–0.72; p < 0.001). Finally, the area under the summary receiver operating curve (AUC) was significantly greater (p < 0.001) in TCD (AUC = 0.98, 95% CI = 0.97–0.99) compared to TTE studies (AUC = 0.86, 95% CI = 0.82–0.89). Interpretation TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE. Ann Neurol 2016;79:625–635
Document Type
Journal Article
Access Rights
ERA Access