{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T16:43:49Z","timestamp":1786293829824,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Resting right\u2010to\u2010left shunt (RLS) may represent a persistent functional shunt phenotype compared with provoked\u2010only shunting. However, its association with ischemic stroke among patients clinically referred for contrast\u2010enhanced transthoracic echocardiography (c\u2010TTE)\u2010based RLS assessment remains incompletely characterized. Because such patients are referred according to clinical suspicion rather than population\u2010based screening, findings from this setting require cautious interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single\u2010center retrospective cross\u2010sectional study at Taizhou People's Hospital. Consecutive outpatients and inpatients clinically referred for c\u2010TTE\u2010based RLS assessment between July 2024 and June 2025 were screened. Patients with incomplete key clinical, laboratory, or echocardiographic data were excluded, and analyses were performed on a complete\u2010case basis. Ischemic stroke was identified on the basis of compatible focal neurological symptoms and radiologic evidence of acute infarction. Resting RLS was defined as microbubble passage into the left\u2010sided cardiac chambers without provocation and was graded semiquantitatively from 0 to 3. Multivariable logistic regression was used to examine the association between resting RLS and ischemic stroke status after adjustment for clinically relevant covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1328 consecutive patients clinically referred for c\u2010TTE\u2010based RLS assessment, 717 with complete data were included in the final analytic cohort. Ischemic stroke was present in 161 patients (22.5%), and resting RLS was present in 156 patients (21.8%). Resting RLS was more frequent in patients with stroke than in those without stroke (32.9%\u00a0vs. 18.5%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). In multivariable analysis, resting RLS was associated with ischemic stroke status (adjusted OR 2.30, 95% CI 1.52\u20133.50;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). When analyzed as an ordinal variable, each one\u2010grade increase in resting RLS was associated with higher odds of stroke status (adjusted OR 1.50, 95% CI 1.23\u20131.84;\n                      <jats:italic>P<\/jats:italic>\n                      for trend &lt; 0.001). Exploratory ROC analysis showed an AUC of 0.715 for the model including resting RLS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this clinically referred complete\u2010case cohort undergoing c\u2010TTE\u2010based RLS assessment, resting RLS and higher resting RLS grade were associated with ischemic stroke status after adjustment for available conventional vascular risk factors. Given the retrospective referral\u2010based design, complete\u2010case selection, and limited availability of medication information, these findings should be interpreted as hypothesis\u2010generating and require prospective validation in broader, systematically evaluated populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70537","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T10:21:42Z","timestamp":1782210102000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Resting Right\u2010to\u2010Left Shunt With Ischemic Stroke Among Patients Referred for Contrast Echocardiographic Screening: A Retrospective Cross\u2010Sectional Study"],"prefix":"10.1111","volume":"43","author":[{"given":"Liang","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Cardiology The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University  Taizhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shutong","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University  Taizhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binhan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University  Taizhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meixiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University  Taizhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University  Taizhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gecai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University  Taizhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2021.07.027"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140\u20106736(91)93206\u2010O"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/genes13010048"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.046"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.063"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40001\u2010022\u201000855\u20100"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.018153"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2021.01.004"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000342900"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40779\u2010023\u201000463\u2010x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886\u2010024\u201002073\u2010y"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.29.7.1322"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.06.064"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a08d59"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705915"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1610057"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707404"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.12.059"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.10.061"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00567"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.02.068"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.20956"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.3248"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/svn\u20102018\u2010000173"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1159\/000500501"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12030941"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.0458"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.855656"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e318296aeca"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.036084"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70537","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70537","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70537","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T16:40:09Z","timestamp":1786293609000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70537"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/echo.70537"],"URL":"https:\/\/doi.org\/10.1111\/echo.70537","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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