Key result
PFO in acute PE is linked to ~436% higher ischemic stroke risk.
Why the study?
Patients with acute pulmonary hypertension during acute PE can develop stroke due to paradoxical embolism via a PFO, but the associated risks of ischemic stroke and mortality required systematic evaluation.
Does the presence of a patent foramen ovale increase the risk of ischemic stroke in adult patients with acute pulmonary embolism?
Meta-Analysis (n=1,197)
Does the presence of a patent foramen ovale increase the risk of ischemic stroke in adult patients with acute pulmonary embolism?
In patients with acute pulmonary embolism, the presence of a patent foramen ovale is associated with a more than 5-fold increased risk of ischemic stroke.
Answers are grounded in this paper and cite their sources.
May prompt PFO screening for stroke risk stratification in acute PE; leaves open whether closure or intensified therapy alters outcomes.
OBJECTIVE: Patients with acute pulmonary hypertension during an acute pulmonary embolism (PE) can develop stroke due to paradoxical embolism in the presence of a patent foramen ovale (PFO). We evaluated the current evidence regarding the risk of ischemic stroke and mortality in patients with PE and a PFO. METHODS: We performed a systematic review and meta-analysis of studies found on PubMed, the Cochrane Library, Embase, SCOPUS, and the BVS portal. We included full-length reports, prospective observational cohorts, and clinical trials of adult patients (aged ≥18 years) diagnosed with PE and investigating the presence of PFO and new ischemic brain injuries. This study is registered with PROSPERO (CRD42023467133). RESULTS: The initial search identified 1398 articles. After applying exclusion criteria, only 8 articles remained, including a total of 1197 individuals with PE, among whom PFO was identified in 318 patients. Ischemic stroke occurred in 62/318 (19.5 %) individuals in the PFO group and in 40/879 (4.5 %) individuals in the non-PFO group. The prevalence of ischemic stroke in the PFO group was higher than in the non-PFO group in all eight studies. The meta-analysis showed that PFO was significantly associated with ischemic stroke in patients with PE compared to those without PFO (odds ratio 5.36, 95 % CI 3.20-8.99, p < 0.00001; I² = 0 %). Three studies also reported higher mortality in the PFO group. CONCLUSION: Patent foramen ovale is a common condition in patients with acute PE and is associated with a higher incidence of ischemic stroke and increased mortality.
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Lucas et al. (2024) conducted a meta-analysis in Pulmonary embolism (n=1,197). Patent foramen ovale (PFO) vs. No PFO was evaluated on Ischemic stroke (OR 5.36, 95% CI 3.20-8.99, p=< 0.00001). In patients with acute pulmonary embolism, the presence of a patent foramen ovale was associated with a higher risk of ischemic stroke.
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