Key result
Cryptogenic stroke linked to ~39-fold higher odds of RLS volume reduction versus known stroke etiology.
Why the study?
Does right-to-left shunt volume decrease over time in patients with stroke and patent foramen ovale?
Observational (n=102)
Single-blind (evaluators blinded to clinical data)
No
Does right-to-left shunt volume decrease over time in patients with stroke and patent foramen ovale?
Odds Ratio: 39.2 (95% CI 6–258.2)
Absolute Event Rate: 69.2% vs 6.3%
p-value: p=<0.001
Right-to-left shunt volume across a PFO decreases over time, particularly in patients with cryptogenic stroke, which may impact secondary stroke prevention strategies.
Shunt reduction may prompt repeat quantification before PFO closure; leaves open effects on secondary prevention in cryptogenic stroke.
BACKGROUND: In patients with patent foramen ovale (PFO) there is evidence supporting the hypothesis of a change in right-to-left shunt (RLS) over time. Proven, this could have implications for the care of patients with PFO and a history of stroke. The following study addressed this hypothesis in a cohort of patients with stroke and PFO. METHODS: The RLS volume assessed during hospitalisation for stroke (index event/T0) was compared with the RLS volume on follow-up (T1) (median time between T0 and T1 was 10 months). In 102 patients with a history of stroke and PFO the RLS volume was re-assessed on follow-up using contrast-enhanced transcranial Doppler/duplex (ce-TCD) ultrasound. A change in RLS volume was defined as a difference of ≥20 microembolic signals (MES) or no evidence of RLS during ce-TCD ultrasound on follow-up. RESULTS: There was evidence of a marked reduction in RLS volume in 31/102 patients; in 14/31 patients a PFO was no longer detectable. An index event classified as cryptogenic stroke (P < 0.001; OD = 39.2, 95% confidence interval 6.0 to 258.2) and the time interval to the follow-up visit (P = 0.03) were independently associated with a change in RLS volume over time. CONCLUSIONS: RLS volume across a PFO decreases over time, especially in patients with cryptogenic stroke. These may determine the development of new strategies for the management in the secondary stroke prevention.
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Tanislav et al. (2010) conducted an observational in Cryptogenic stroke and patent foramen ovale (PFO) (n=102). Cryptogenic stroke vs. Stroke of known etiology was evaluated on Change in right-to-left shunt (RLS) volume (≥20 microembolic signals difference or no evidence of RLS on follow-up) (OR 39.2, 95% CI 6.0-258.2, p=<0.001). An index event of cryptogenic stroke was independently associated with a marked reduction in right-to-left shunt volume over time compared to stroke of known etiology (OR 39.2).
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