Key result
Patent foramen ovale was significantly more prevalent in patients with cryptogenic stroke compared to those with other stroke etiologies (30.9% vs. 21.9%; p<0.002).
Why the study?
Is patent foramen ovale (PFO) with or without atrial septum aneurysm (ASA) associated with cryptogenic stroke and admission stroke severity?
Cross-Sectional (n=909)
No
Is patent foramen ovale (PFO) with or without atrial septum aneurysm (ASA) associated with cryptogenic stroke and admission stroke severity?
Absolute Event Rate: 30.9% vs 21.9%
p-value: p=< 0.002
Patent foramen ovale is more prevalent in cryptogenic stroke compared to other etiologies and is associated with lower admission stroke severity.
May inform PFO evaluation in cryptogenic stroke; this cross-sectional study leaves open causal and therapeutic implications.
BACKGROUND: A significant proportion of ischemic strokes are cryptogenic. In this context, the clinical pertinence of patent foramen ovale (PFO) with and without atrial septum aneurysm (ASA) remains controversial. The aim of this study was to identify how PFO +/-ASA and cryptogenic stroke are associated in a representative sample of stroke patients. METHODS: We enrolled all patients (n = 909) with ischemic stroke or transient ischemic attack admitted to the certified stroke unit or neurological intensive care unit of our university medical center who underwent transesophageal echocardiography (TEE) between 2012 and 2014. The baseline characteristics, cardio-/neurovascular risk factors, clinical parameters and TEE findings were analyzed. RESULTS: PFO was present in 26.2%, and PFO was combined with an ASA in 9.9%. In cryptogenic stroke, the prevalence of PFO was higher compared to other etiologies (30.9 vs. 21.9%; p < 0.002). Patients with PFO had lower National Institute of Health Stroke Score (NIHSS) values at admission than those without (2 [0-5] vs. 3 [1-7]; p = 0.001; 95% CI [0.62-0.88]). No difference was found in NIHSS values of PFO patients with or without ASA (2 [0-5] vs. 2 [0-5]; p = 0.683; 95% CI 0.94 [0.68-1.28]). CONCLUSIONS: Our study indicates that a detected PFO +/-ASA could exhibit a stroke-relevant finding, if classical risk factors for the stroke were lacking.
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Schnieder et al. (2017) conducted a cross-sectional in Ischemic stroke or transient ischemic attack (n=909). Patent foramen ovale (PFO) vs. No PFO / other stroke etiologies was evaluated on Prevalence of PFO in cryptogenic stroke versus other etiologies (p=< 0.002). Patent foramen ovale was significantly more prevalent in patients with cryptogenic stroke compared to those with other stroke etiologies (30.9% vs. 21.9%; p<0.002).
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