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.

This study evaluated the effectiveness of right-heart contrast echocardiography (RHCE) with the Valsalva manoeuvre. It focused on screening for patent foramen ovale (PFO) in migraine patients. A total of 232 patients were enrolled between April 2023 and December 2024. Each patient underwent RHCE while performing a standardized Valsalva manoeuvre. Transoesophageal echocardiography (TEE) served as the reference standard. The PFO-positive rate was 62%. The sensitivity was 92%, and specificity was 85%. The accuracy of the screening method was 89%. The study found a significant difference in PFO prevalence between patients with aura and those without. The PFO prevalence was 71% in patients with aura and 55% in those without. A limitation of the study was the lack of quantitative measurement of intrathoracic pressure during the manoeuvre. RHCE with Valsalva is effective for PFO screening in migraine patients without secondary causes. Clinical relevance: This research shows that RHCE combined with Valsalva effectively screens for PFO in migraine patients, potentially improving patient care and treatment options.