Association Between Cardiac Computed Tomography-Detected Patent Foramen Ovale and Risk of Ischemic Stroke

Patent foramen ovale (PFO) is associated with embolic stroke; however, the prognostic significance of PFO detected by cardiac computed tomography (CT) remains unclear. Objectives: This study aimed to evaluate the association between CT-detected PFO and subsequent ischemic stroke risk, and to assess its agreement with transthoracic echocardiography with agitated saline (Bubble-TTE). We retrospectively analyzed 1,028 patients who underwent cardiac CT between 2016 and 2018. PFO was diagnosed on cardiac CT using criteria adapted from previous reports. In a subset of 86 patients, intermodality agreement between cardiac CT and Bubble-TTE was assessed. The primary outcome was ischemic stroke, and the secondary outcome was all-cause mortality. CT-detected PFO was identified in 212 patients (20.6%). In the subset analysis, cardiac CT showed moderate agreement with Bubble-TTE for PFO detection (κ = 0.41, p < 0.001). During follow-up, ischemic stroke occurred in 49 patients (4.7%), and 116 patients died (11.3%). CT-detected PFO was independently associated with ischemic stroke (adjusted hazard ratio 2.41, 95% confidence interval 1.36-4.29, p = 0.003), whereas no significant association was observed with all-cause mortality (adjusted hazard ratio 0.96, 95% confidence interval 0.61-1.50, p = 0.86). In conclusion, CT-detected PFO was associated with an increased risk of ischemic stroke but not with all-cause mortality, suggesting prognostic relevance for ischemic stroke.