Key result
A change in patent foramen ovale height of ≥1.85 mm during the Valsalva maneuver was independently associated with cryptogenic stroke (OR 2.57), contributing to a novel morphology-based scoring system.
Why the study?
PFO occlusion is recommended for PFO-related cryptogenic stroke, but identifying the causative foramen ovale remains challenging.
Does PFO morphology predict cryptogenic stroke in patients with patent foramen ovale?
Case-Control (n=222)
Single-blind
Yes
Does PFO morphology predict cryptogenic stroke in patients with patent foramen ovale?
Odds Ratio: 2.57 (95% CI 1.08–6.12)
p-value: p=0.033
A novel morphology-based scoring system incorporating dynamic changes in PFO height can help identify high-risk PFOs associated with cryptogenic stroke to guide closure decisions.
PFO scoring system may aid CS closure decisions; leaves open prospective validation before clinical adoption.
Introduction: Current guidelines recommended patent foramen ovale (PFO) occlusion as the preferred treatment for PFO-related cryptogenic stroke (CS); however, finding the causative foramen ovale remains challenging. This study aimed to identify predictors and establish a scoring system by assessing PFO morphology and stroke-related factors. Methods: Based on a prospective multicenter registered clinical trial, we compared data mainly derived from transesophageal echocardiography (TEE) and clinical history in patients with PFO-related CS and those without CS (non-CS) with incidental PFO. Subsequently, we explored independent predictors using logistic analysis, established a scoring system based on the results, and finally evaluated the scoring system using receiver operating characteristic (ROC) analysis and internal validation. Results: 75 patients with PFO-related CS and 147 non-CS patients were enrolled. Multivariate logistic analysis showed that the change in PFO height, large PFO, atrial septal aneurysm (ASA), and sustained right-to-left shunt (RLS) had independent relationships with CS. Based on the odds ratio value of each independent factor, a scoring system was built: change in PFO height ≥ 1.85 mm (3 points), large PFO (2 points), ASA (5 points), sustained RLS (2 points). 0-2 points correspond to low-risk PFO, 3-5 points medium-risk PFO, and 7-12 points high-risk PFO. ROC analysis showed an area under the curve of 0.80 to predict CS. The proportion of patients with CS is increasing based on these points. Conclusions: Our study screened out the change in PFO height as an independent predictor of CS. A simple and convenient scoring system can provide constructive guidance for identifying whether the PFO is causal and consequently selecting patients more likely to benefit from closure.
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Liu et al. (2022) conducted a case-control in Cryptogenic stroke and incidental patent foramen ovale (n=222). Change in patent foramen ovale height ≥1.85 mm vs. Change in patent foramen ovale height <1.85 mm was evaluated on Association with cryptogenic stroke (OR 2.57, 95% CI 1.08-6.12, p=0.033). A change in patent foramen ovale height of ≥1.85 mm during the Valsalva maneuver was independently associated with cryptogenic stroke (OR 2.57), contributing to a novel morphology-based scoring system.
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