Patent foramen ovale prevalence in the Greek population is high, yielding a moderate PFO attributable fraction of 57% even among cryptogenic stroke patients with very high RoPE scores (9-10).
Observational (n=282)
What is the prevalence of PFO in the Greek population and how does it impact the interpretation of the RoPE score in cryptogenic stroke patients?
The prevalence of PFO in the Greek population is higher than previously accepted, suggesting that the established RoPE score cutoff of ≥7 may overestimate the probability of PFO-associated stroke in this population.
p-value: p=0.04
BACKGROUND: The risk of paradoxical embolism (RoPE) score calculates the probability that patent foramen ovale (PFO) is causally related to stroke (PFO attributable fraction, PFOAF), based on PFO prevalence in patients with cryptogenic stroke (CS) compared with that in the general population. The latter has been estimated at 25%; however, PFO prevalence in nonselected populations varies widely. METHODS: Since PFO prevalence in Greece remains unknown, we evaluated it and we calculated PFOAF stratified by RoPE score in a cohort of patients with CS ⩽55 years old. PFO was detected according to the international consensus transcranial Doppler (TCD) criteria in 124 healthy subjects (H), in 102 patients with CS, and in 56 patients with stroke of known cause (nonCS). Each subject underwent unilateral middle cerebral artery recording after infusion of agitated saline, at rest, and after a controlled Valsalva maneuver. We characterized PFO as large (>20 microbubbles or curtain), moderate (11-20), and small (⩽10). RESULTS: = 0.04]. The median RoPE score in patients with CS and PFO was seven. Even patients with very high RoPE score (9-10) had moderate PFOAF (57%). For any individual stratum up to RopE score 8, PFOAF was <33%. CONCLUSIONS: PFO prevalence in the Greek population is much higher than the widely accepted 25%. PFO may be the cause of stroke in one out of nine Greek patients with CS. Among Greek CS patients who harbor a PFO, the latter is causal in one out of five. The established RoPE score cutoff of ⩾7 for having a probable PFO-associated stroke may overestimate the probability in patients deriving from populations with high PFO prevalence.
Koutroulou et al. (Wed,) conducted a observational in Cryptogenic stroke (n=282). Patent foramen ovale vs. No patent foramen ovale was evaluated on PFO attributable fraction (PFOAF) (p=0.04). Patent foramen ovale prevalence in the Greek population is high, yielding a moderate PFO attributable fraction of 57% even among cryptogenic stroke patients with very high RoPE scores (9-10).