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Is inferior vena cava compression an alternative for valsalva maneuver in contrast-enhanced transcranial doppler？

Yitao He1, Jian Deng1, Jingmei Tu1

  • 1Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, China.

Echocardiography (Mount Kisco, N.Y.)
|December 2, 2019
PubMed

Insights

Inferior vena cava compression (IVCC) can supplement the Valsalva maneuver (VM) for detecting right-to-left shunts (RLS) in contrast-enhanced transcranial Doppler (c-TCD) scans, especially in patients with poor VM cooperation.

Area of Science:

  • Neuroimaging
  • Cardiovascular Physiology
  • Neurology

Background:

  • Contrast-enhanced transcranial Doppler (c-TCD) is crucial for detecting right-to-left shunts (RLS).
  • The Valsalva maneuver (VM) is commonly used to enhance RLS detection during c-TCD.
  • Patient cooperation with VM can be a limiting factor.

Purpose of the Study:

  • To evaluate Inferior Vena Cava Compression (IVCC) as an alternative to VM in c-TCD for RLS detection.
  • To assess the efficacy of IVCC across different patient cooperation levels and abdominal obesity statuses.

Main Methods:

  • 246 patients with ischemic stroke, TIA, or migraine underwent c-TCD.
  • RLS detection was performed at rest, after VM, and after IVCC.
  • Statistical analysis (Wilcoxon signed-rank test) compared RLS detection rates.

Main Results:

  • IVCC improved RLS detection compared to resting state (P < .001).
  • IVCC was inferior to VM in overall RLS detection (P = .01).
  • IVCC was superior to VM in patients with poor VM cooperation (P < .001) and in those with abdominal obesity compared to resting state (P < .001).

Conclusions:

  • IVCC is an effective supplement to VM for enhancing RLS detection in c-TCD.
  • IVCC is particularly beneficial for patients with poor VM cooperation.
  • IVCC can improve RLS detection in patients with abdominal obesity.
Abstract

Keywords:
abdominal obesitycontrast-enhanced transcranial dopplerinferior vena cava compressionright to left shuntvalsalva maneuver

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