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Cardiac CT Angiography in Diagnosing Patent Foramen Ovale: A Study on Patients with Suspected Patent Foramen
Lijie Sun1, Chong Zheng2, Zhenxing Fan1
1Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China.
Insights
Cardiac computed tomographic angiography (CTA) shows variable accuracy in detecting patent foramen ovale (PFO). CTA is more reliable for PFO detection in stroke patients with moderate to large right-to-left shunts.
Area of Science:
- Cardiology
- Radiology
- Neurology
Background:
- Patent foramen ovale (PFO) is linked to cryptogenic stroke.
- Cardiac computed tomographic angiography (CTA) accuracy for PFO detection varies.
- Identifying factors influencing CTA's PFO detection is crucial.
Purpose of the Study:
- To investigate factors affecting cardiac CTA detectability of PFO.
- To compare CTA PFO detection with transesophageal echocardiography (TEE) in stroke patients.
- To identify predictors of false-negative CTA results for PFO.
Main Methods:
- Retrospective study of 108 patients with suspected PFO-associated stroke.
- Patients underwent contrast transcranial Doppler (cTCD), cardiac CTA, and TEE.
- Logistic regression analyzed predictors of CTA false-negative PFO findings.
Main Results:
- PFO prevalence was 94.4% by TEE.
- Cardiac CTA sensitivity was 70% compared to TEE.
- Moderate to large right-to-left shunts (RLS) were associated with significantly lower CTA false-negative rates (OR 0.113).
Conclusions:
- Cardiac CTA can be a valuable complementary tool for PFO detection in selected stroke patients.
- CTA's diagnostic performance for PFO is enhanced in patients with moderate to large RLS.
- CTA accuracy for PFO is more reliable with larger shunts.
Background:
Cardiac computed tomographic angiography (CTA) detects patent foramen ovale (PFO) with variable accuracy. This study investigated factors affecting CTA detectability for PFO in patients with suspected PFO-associated stroke.
Methods:
Consecutive patients with cryptogenic stroke and positive findings on contrast transcranial Doppler (cTCD) examinations were enrolled between November 2020 and April 2023 in this retrospective study. Each participant underwent transesophageal echocardiography (TEE) and cardiac CTA. Patients with confirmed PFO on TEE were categorized into two groups based on CTA detectability: the CTA-positive group (PFO identified by CTA) and the CTA-negative group (PFO missed by CTA). Univariate and multivariate logistic regression analyses were performed to identify predictors of CTA false-negative results.
Results:
Among 108 patients (mean age 46.7 ± 14.9 years, 47.2% male), the prevalence of PFO by TEE was 94.4% (102/108). Compared to TEE, cardiac CTA had a sensitivity of 70% (95% CI 61-79%), a specificity of 100% (95% CI 54-100%), a positive predictive value of 100% (95% CI 95-100%), and a negative predictive value of 16% (95% CI 6-32%). Among patients with PFO confirmed by TEE (n = 102), the incidence of moderate to large right-to-left shunts (RLS) was significantly higher in the CTA-positive group than in the CTA-negative (77.5% vs. 22.5%, p < 0.001). After adjusting for confounders, patients with moderate to large shunts showed a significantly lower likelihood of a CTA false-negative result compared to those with small shunts (OR 0.113, 95% CI 0.035-0.365, p < 0.001). In patients with moderate to large RLS, the sensitivity of cardiac CTA for diagnosing PFO increased to 90.16% (95% CI 82.69-97.64%).
Conclusions:
Cardiac CTA could be an effective complementary modality for selected patients with suspected PFO-associated stroke. Its diagnostic performance appears more reliable for identifying PFO in patients with moderate-to-large RLS than in those with small RLS.
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