BACKGROUND Although transthoracic echocardiography (TTE) may be useful for patent foramen ovale (PFO) screening, the optimal methodologies remain unclear. The aims of this study were to evaluate the efficacy of the abdominal compression Valsalva maneuver and identify the optimal cutoff value of microbubbles in contrast TTE for detecting PFO, compared with transesophageal echocardiography and catheterization as the reference. METHODS One hundred thirty-four patients with cryptogenic stroke or migraine who had suspected PFO and underwent TTE and transesophageal echocardiography plus catheterization were enrolled. The sensitivity, specificity, and accuracy of TTE for PFO detection were analyzed according to different provocations (spontaneous Valsalva maneuver, abdominal compression Valsalva maneuver) and different cutoff values of microbubbles for a positive result (at least one microbubble, at least five microbubbles). RESULTS Eighty patients had PFO confirmed by transesophageal echocardiography and catheterization. When the cutoff was at least one microbubble, the sensitivity of TTE in detecting PFO was 93% with the spontaneous Valsalva maneuver and 99% with the abdominal compression Valsalva maneuver. When the cutoff was at least five microbubbles, sensitivity was 85% with the spontaneous Valsalva maneuver and 99% with the abdominal compression Valsalva maneuver. With the abdominal compression Valsalva maneuver, specificity was increased using the cutoff of at least five microbubbles compared with at least one microbubble (89% vs 57%). The abdominal compression Valsalva maneuver with the cutoff of at least 5 microbubbles provided the greatest accuracy of 95%. CONCLUSIONS TTE with the abdominal compression Valsalva maneuver had excellent sensitivity. The cutoff of at least five microbubbles increased specificity. Our findings suggest that TTE with these criteria is valuable for PFO diagnosis.

中文翻译：

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经胸超声心动图对比腹腔压迫瓦尔氏治疗和微泡分级对检测卵圆孔的重要性。

背景技术尽管经胸超声心动图（TTE）可用于卵圆孔未闭（PFO）筛查，但最佳方法仍不清楚。这项研究的目的是评估经腹部食管Valsalva动作的效果，并确定对比TTE检测PFO的微泡的最佳截止值，以经食管超声心动图和导管检查为参考。方法134例疑似PFO并接受TTE和经食道超声心动图加导管检查的隐源性中风或偏头痛患者入选。根据不同的挑衅行为（自发的瓦尔萨尔瓦动作，腹部压迫Valsalva动作）和不同的微气泡截止值以获得阳性结果（至少一个微气泡，至少五个微气泡）。结果经食道超声心动图检查和导管检查证实有80例PFO。当临界值至少为一个微泡时，自发性Valsalva动作的TTE检测PFO的敏感性为93％，而腹部压迫Valsalva动作的检测为99％。当临界值至少为5个微气泡时，自发性Valsalva动作的敏感性为85％，腹部压迫Valsalva动作的敏感性为99％。与腹部压迫法相比，采用至少5个微泡的截断法可以提高腹部的Valsalva操纵性（89％比57％）。腹部压迫Valsalva动作至少截止5个微气泡，可提供95％的最高准确度。结论TTE腹部加压Valsalva动作具有极好的敏感性。至少五个微泡的截止增加了特异性。我们的发现表明，符合这些标准的TTE对于PFO诊断很有价值。