The diagnostic value of transcranial Doppler ultrasound foam test,right heart acoustic contrast imaging combined with serum GDF15 and COX-2 levels for right-to-left shunt in migraine

ZHENG Yao; JIA Linnan; WANG Zhihui; QU Haili; WANG Baoyue

doi:10.20258/j.cnki.1006-9011.2026.01.004

Abstract：Objective To explore the diagnostic value of transcranial Doppler ultrasound foam test(cTCD),right heart acoustic contrast(cTTE)combined with serum growth differentiation factor 15(GDF15)and cyclooxygenase-2(COX-2)levels for right-to-left shunt(RLS)in patients with migraine.Methods 104 of migraine patients suspected of having RLS(the obser-vation group)were selected,along with 95 healthy volunteers(the control group)from the same period.The observation group all underwent cTCD,cTTE and transesophageal echocardiography(cTEE)examinations.Serum GDF15 and COX-2 were de-tected by ELISA;the consistency of cTCD,cTTE with the gold standard for diagnosing RLS was analyzed by Kappa test;the cor-relation between serum GDF15,COX-2 levels and the grade of shunt volume in patients with migraine combined with RLS was analyzed by Spearman analysis;and the diagnostic efficacy of serum GDF15,COX-2 levels for migraine combined with RLS was analyzed by ROC curve.Results The cTEE examination revealed that,among 104 patients with migraine,59 had RLS.Based on the diagnostic results,the migraine patients were divided into the RLS positive(n=59).The cTCD test identified 54 cases of RLS as positive,with a sensitivity of 83.05%and a specificity of 88.89%,and an accuracy of 85.58%.The cTTE test identified 57 cases of RLS as positive,with a sensitivity of 86.44%,a specificity of 86.67%,and an accuracy of 86.54%.Com-pared with the control group,the levels of serum GDF15 and COX-2 in the observation group were higher(t=21.678,17.009,all P<0.05).Compared with the RLS negative group,the levels of serum GDF15 and COX-2 in the RLS positive group were also higher(t=11.587,10.270,all P<0.05).The Spearman analysis showed that the levels of serum GDF15 and COX-2 were significantly positively correlated with the microembolic signal(MES)flow grade in patients with migraine combined with RLS the correlation coefficients were 0.516 and 0.539 respectively(all P<0.05).The ROC curve analysis showed that the individual sensitivity of serum GDF15 and COX-2 levels in diagnosing migraine combined with RLS was 74.58%and 77.97%,respec-tively.The combined use of cTCD,cTTE and serum GDF15,COX-2 levels in diagnosing migraine combined with RLS had a sensitivity of 94.92%,a specificity of 84.44%,an accuracy rate of 90.38%,and the Kappa test indicated a high consistency be-tween the combined diagnosis and the gold standard(Kappa=0.802,P<0.05).Conclusion The combination of cTCD and cTTE with serum GDF15 and COX-2 has a relatively high diagnostic efficacy for migraine combined with RLS,which is helpful for clinical diagnosis.