The diagnostic efficacy of transthoracic contrast echocardiography combined with serum c Tn I and D-D for patent foramen ovale in cryptogenic stroke

Zheng Wenya

Wang Yunsheng

Yuan Changchong

Ma Fang

Liang Lilong

Zhang Chi

Department of Ultrasound,the Second People's Hospital of Hefei/Hefei Hospital Affiliated to Anhui Medical University

Abstract:Objective To explore the diagnostic efficacy of contrast transthoracic echocardiography(c TTE)combined with serum cardiac troponin I(cTnI) and D-dimer(D-D) for patent foramen ovale(PFO) in patients with cryptogenic stroke(CS). Methods A total of 195 patients with suspected PFO-related CS were selected from April 2023 to May 2025 in the Department of Cardiovascular Medicine of Hefei Second People' s Hospital, and were divided into a PFO-positive group(87 cases) and a PFO-negative group(108 cases) using transesophageal echocardiography(TEE) as the gold standard. ELISA was used to detect serum c Tn I and D-D levels. ROC curve analysis was used to evaluate the diagnostic value of serum c Tn I and D-D for PFO. The four-grid table method was used to evaluate the diagnostic results of c TTE combined with serum c Tn I and D-D for PFO, and the Kappa test was used to assess consistency. Results Compared with the PFO-negative group, serum c Tn I and D-D levels were significantly increased in the PFO-positive group(t/P = 8.866/<0.001, 9.284/<0.001). The consistency of c Tn I, D-D, and c TTE with TEE was moderate(Kappa value/P = 0.538/<0.001, 0.437/<0.001, 0.550/<0.001), and the consistency of the combined diagnostic results with TEE was significantly improved(Kappa value/P = 0.716/<0.001), with positive predictive values of 77.57% and 95.45% for the combined test. The AUCs of c TTE, serum c Tn I, D-D, and their combination for diagnosing PFO were 0.773, 0.824, 0.803, and 0.946, respectively. The combination of the three was significantly superior to individual diagnosis(Z/P = 4.410/<0.001, 4.804/<0.001, 6.183/<0.001). Within the threshold probability range of 0.02 to 0.91, the combined model demonstrated a significant net benefit advantage. Conclusion In CS patients with PFO, serum c Tn I and D-D levels are upregulated. The combination of these markers with c TTE can significantly improve the diagnostic efficiency for PFO, showing good prospects for clinical application.

Keyword:Patent foramen ovaleCryptogenic strokeContrast transthoracic echocardiographyCardiac troponin ID-dimer

Fund:Health Research Project of Anhui Provincial Health Commission (AHWJ2023A20458);Scientific Research Project of Hefei Second People's Hospital (2024ykc030)