Positive Relationship Between Paroxysmal Vertigo and Right-to-Left Shunt: A Large Observational Study

Abstract

Background: The association between paroxysmal vertigo and right-to-left shunt (RLS) is rarely reported. This study investigates the prevalence and correlation of RLS in patients with different paroxysmal vertigo diseases.

Methods: Patients with paroxysmal vertigo from seven hospitals in China were included in this observational study between 2017 and 2021. Migraine patients within the same period were included for comparison. Demographic data and medical history were collected; contrast transthoracic echocardiography was performed; and the clinical features, Dizziness Handicap Inventory, and incidence of RLS in each group were recorded.

Results: A total of 2,751 patients were enrolled. This study's results demonstrated that the proportion of RLS in patients with benign recurrent vertigo (BRV) and vestibular migraine (VM) was significantly higher than that in patients with benign paroxysmal positional vertigo, Meniere's disease, and vestibular paroxysmia (P < 0.05). No statistical difference was shown between the frequency of RLS in patients with BRV and those with migraine and VM. A positive correlation was shown between the RLS grade and Dizziness Handicap Inventory scores of patients with VM and BRV (P < 0.01) after effectively controlleding the effect of confounding variables.

Conclusions: RLS was significantly associated with BRV and VM. RLS may be involved in the pathogeneses of BRV and VM and may serve as a differential reference index for the paroxysmal vertigo.

Trial registration: CHRS, NCT04939922, registered 14 June 2021- retrospectively registered, https://register.clinicaltrials.gov.

Keywords: benign recurrent vertigo; contrast transthoracic echocardiography; paroxysmal vertigo; right-to-left shunt; vestibular migraine.

Figure 1

Flowchart of the inclusion and exclusion of patients.

Figure 2

Frequency of right-to-left shunt (RLS) in patients with different diseases. There is a statistical difference between the frequency of RLS in patients with benign recurrent vertigo (BRV) and that in patients with Meniere's disease (MD), benign paroxysmal positional vertigo (BPPV), and vestibular paroxysmia (VP). The proportion of RLS in patients with BRV is significantly higher than that in patients with MD, BPPV, and VP (P < 0.05). The proportion of RLS in patients vestibular migraine (VM) with and without migrainous headaches is also significantly higher than that in patients with MD, BPPV, and VP (P < 0.05). However, there is no statistical difference between the frequency of RLS in patients with BRV and that in migraine without aura (P = 0.931), MA (P = 0.997), VM with migrainous headache (P = 0.787), and VM without migrainous headache (P = 0.754). BPPV, benign paroxysmal positional vertigo; BRV, benign recurrent vertigo; MA, migraine with aura; MD, Meniere's disease; MoA, migraine without aura; RLS, right-to-left shunt; VM, vestibular migraine; VP, vestibular paroxysmia. *P < 0.05.

Figure 3

Dizziness Handicap Inventory (DHI) scores and the right-to-left shunt (RLS) grades in patients with vestibular migraine (VM) and benign recurrent vertigo (BRV). (A) In patients with VM with migrainous headaches, the DHI scores increase with increasing RLS grades, and there is a positive correlation between them. (B) In patients with VM without migrainous headaches, the DHI scores increase with increasing RLS grades, and there is a positive correlation between them. (C) In patients with BRV, the DHI scores increase with increasing RLS grades, and there is a positive correlation between them. (D) In all patients with VM or BRV, the DHI scores increase with increasing RLS grades, and there is a positive correlation between them. DHI, Dizziness Handicap Inventory; RLS, right-to-left shunt; VM, vestibular migraine; BRV, benign recurrent vertigo.