Efficacy Evaluation of Right‐Heart Contrast Echocardiography Combined With the Valsalva Manoeuvre in Screening for Patent Foramen Ovale in Patients With Migraine Without an Identified Secondary Cause
Haijuan Gu, Jiesheng Xia, Zhenhua Xu, Jianwei ShiABSTRACT
Objective
This study aimed to validate the efficacy of right‐heart contrast echocardiography (RHCE) combined with the Valsalva manoeuvre for screening for patent foramen ovale (PFO) in patients with migraine without an identified secondary cause.
Methods
We enrolled 232 patients between April 2023 and December 2024. All underwent RHCE with a standardized Valsalva manoeuvre, using transoesophageal echocardiography (TEE) as the reference standard. Diagnostic performance, consistency and correlations were analyzed. A major methodological limitation of this study was that intrathoracic pressure during the Valsalva manoeuvre was not quantitatively measured.
Results
The PFO‐positive rate was 61.64% (143/232). Using TEE as the reference standard, the sensitivity was 92.03%, the specificity was 85.14%, the accuracy was 89.22% and the area under the curve was 0.886 (95% confidence interval: 0.841–0.931). Discordant results occurred in 26 patients. The prevalence of PFO was significantly higher in patients with migraine with aura than in those without aura (70.59% vs. 54.72%, p < 0.05).
Conclusion
Right‐heart contrast echocardiography combined with the Valsalva manoeuvre is a non‐invasive, convenient and effective method for PFO screening in patients with migraine without an identified secondary cause, especially those with aura.