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Transcranial Doppler to Detect Right to Left Communication: Evaluation Versus Transesophageal Echocardiography in

Alexandre Maillet1, Antoine Pavero1, Pierre Salaun1

  • 11 Service de Médecine Vasculaire, Hôpital St André, Bordeaux, France.

Angiology
|June 7, 2017
PubMed

Insights

Transcranial Doppler (TCD) effectively detects right to left cardiac communication (RLC), even when other methods like transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) are negative. TCD may serve as a preferred initial diagnostic tool for RLC.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Right to left cardiac communication (RLC) is a potential cause of embolic events.
  • Accurate detection of RLC is crucial for patient management and stroke prevention.

Purpose of the Study:

  • To compare the sensitivity of transcranial Doppler (TCD) with transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in detecting RLC.
  • To evaluate the utility of TCD as a first-line diagnostic tool for RLC.

Main Methods:

  • A retrospective analysis of 101 patients evaluated for RLC using TCD between 2013 and 2016.
  • RLC detection via TCD involved monitoring for microembolic signals after intravenous injection of agitated solution.
  • Comparison with TEE and TTE findings in a subset of patients.

Main Results:

  • TCD identified RLC in 53 patients.
  • TCD detected RLC in patients who had negative results with TTE or TEE.
  • A negative TEE did not rule out RLC confirmed by TCD.

Conclusions:

  • Transcranial Doppler demonstrates high sensitivity for detecting right to left cardiac communication.
  • TCD can identify RLC missed by TTE and TEE.
  • TCD is a valuable and potentially first-line method for RLC screening.

Keywords:
cardiovascular diseaseperipheral arterial diseasestrokethrombosis

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