{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T14:40:09Z","timestamp":1768401609794,"version":"3.49.0"},"reference-count":47,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2016,4,20]],"date-time":"2016-04-20T00:00:00Z","timestamp":1461110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Transcranial Doppler (<jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content>) with agitated saline has been shown to be an alternative for the detection of right\u2010to\u2010left shunts (<jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content>) with similar diagnostic accuracies as transesophageal echocardiography (<jats:styled-content style=\"fixed-case\">TEE<\/jats:styled-content>). It is hypothesized that the addition of blood to agitated saline increases the sensitivity of <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> for the detection of <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content>. The aim of this meta\u2010analysis was to determine whether agitated saline with blood increases the sensitivity of <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> for the detection of <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> compared to agitated saline alone and other contrast agents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A systematic review of Medline, Cochrane, and Embase was performed to look for all prospective studies assessing intracardiac <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> using <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> compared with <jats:styled-content style=\"fixed-case\">TEE<\/jats:styled-content> as the reference; both tests were performed with a contrast agent and a maneuver to provoke <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> in all studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 27 studies (29 comparisons) with 1,968 patients met the inclusion criteria. Of 29 comparisons, 10 (35%) used echovist contrast during <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content>, 4 (14%) used a gelatin\u2010based solution, 12 (41%) used agitated saline, and 3 (10%) utilized 2 different contrast agents. The addition of blood to agitated saline improved the sensitivity of <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> to 100% compared to agitated saline alone (96% sensitivity, P = 0.161), echovist (94% sensitivity, P = 0.044), and gelatin\u2010based solutions (93% sensitivity, P = 0.041).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The addition of blood to agitated saline improves the sensitivity of <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> for the detection of <jats:styled-content style=\"fixed-case\">RLS<\/jats:styled-content> to 100% when compared to other conventional contrast agents; these findings support the addition of blood to agitated saline during <jats:styled-content style=\"fixed-case\">TCD<\/jats:styled-content> bubble studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.13231","type":"journal-article","created":{"date-parts":[[2016,4,20]],"date-time":"2016-04-20T09:32:34Z","timestamp":1461144754000},"page":"1219-1227","source":"Crossref","is-referenced-by-count":14,"title":["Transcranial Doppler: Does Addition of Blood to Agitated Saline Affect Sensitivity for Detecting Cardiac Right\u2010to\u2010Left Shunt?"],"prefix":"10.1111","volume":"33","author":[{"given":"Mohammad Khalid","family":"Mojadidi","sequence":"first","affiliation":[{"name":"Division of Cardiology University of Florida Gainesville Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Cardiology Montefiore Medical Center and Jacobi Medical Center Albert Einstein College of Medicine New York New 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