(Stroke. 2000;31:2407.)
© 2000 American Heart Association, Inc.
Original Contributions |
Morphological and Functional Characteristics of Patent Foramen Ovale and Their Embolic Implications
From the Departments of Clinical Medicine (S.D.C., D.C.), Cardiovascular and Respiratory Sciences (F.F.), and Neurological Sciences (M.F., M.R., A.A., E.M.Z., M.B., C.C., C.F.), "La Sapienza" University, Rome, Italy; and the New England Medical Center (N.G.P.), Tufts University, Boston, Mass.
Correspondence to Stefano De Castro, MD, Dipartimento di Medicina Clinica, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy. E-mail migliau{at}axcasp.caspur.it
Background and Purpose—Transesophageal echocardiography (TEE) has detected a high prevalence of patent foramen ovale (PFO) in stroke patients, but the clinical implications of the distinctive characteristics of this patency are still a matter of debate.
Methods—We studied 350 patients with acute ischemic stroke or transient ischemic attack (TIA) within 1 week of admission. Of these, 101 (29%) were identified by contrast TEE to have a PFO; 86 patients (25%) were cryptogenic stroke patients, and 163 were excluded because of the presence of a definite or possible arterial or clinical evidence of a source of emboli or small-vessel disease. Thirteen PFO subjects without a history of embolism were designated as the control group. All PFO and cryptogenic stroke patients were followed up by neurological visits.
Results—Compared with controls, PFO patients with acute stroke or TIA more frequently presented with a right-to-left shunt at rest and a higher membrane mobility (P<0.05). Patients with these characteristics were considered to be at high risk. During a median follow-up period of 31 months (range, 4 to 58 months), 8 PFO and 18 cryptogenic stroke patients experienced recurrent cerebrovascular events. The cumulative estimate of risk of cerebrovascular event recurrence at 3 years was 4.3% (95% confidence interval [CI], 0% to 10.2%) for "low-risk" PFO patients, 12.5% (95% CI, 0% to 26.1%) for "high-risk" PFO patients, and 16.3% (95% CI, 7.2% to 25.4%) for cryptogenic stroke patients (high-risk PFO versus low-risk PFO, P=0.05).
Conclusions—The association of right-to-left shunting at rest and high membrane mobility, as detected by contrast TEE, seems to identify PFO patients with cerebrovascular ischemic events who are at higher risk for recurrent brain embolism.
Key Words: cerebral ischemia • echocardiography • embolism • foramen ovale, patent
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