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

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.