Correlation Between Patent Foramen Ovale Morphological Characteristics and Right-to-Left Shunt Severity in Stroke Patients with High RoPE Scores

Introduction: To evaluate the association between Risk of Paradoxical Embolism (RoPE) score, patent foramen ovale (PFO) morphological characteristics, and right-to-left shunt severity in ischemic stroke patients with high RoPE scores. Methods: In this prospective observational study, 162 ischemic stroke patients with confirmed PFO and RoPE scores ≥7 were enrolled. All patients underwent contrast-enhanced transcranial Doppler, transthoracic echocardiography, and transesophageal echocardiography. PFO morphology (size, tunnel length, atrial septal aneurysm, Eustachian valve, Chiari network) and shunt severity were assessed. Associations between RoPE score, its components, and PFO characteristics were analyzed. Results: Patients with higher RoPE scores (9–10) showed a greater prevalence of complex PFO than those with scores of 7–8 (71.2% vs. 45.4%, p<0.001). RoPE score independently predicted complex PFO morphology (adjusted OR 2.48, 95% CI 1.68–3.67). Younger age and absence of hypertension were the strongest contributing factors. RoPE score correlated positively with shunt severity (ρ=0.58, p<0.001), with severe shunting more frequent in patients with higher scores. Conclusion: Higher RoPE scores are strongly associated with complex PFO anatomy and severe right-to-left shunting. Integrating detailed PFO assessment with clinical risk stratification may improve individualized management of PFO-associated stroke.