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Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both
1Department of Neurology, Sainte-Anne Hospital, Paris V University, Paris, France. mas@chsa.broca.inserm.fr
Insights
Patients with both patent foramen ovale and atrial septal aneurysm face a significantly higher risk of recurrent stroke. Further preventive strategies beyond aspirin are recommended for this high-risk group.
Area of Science:
- Cardiology
- Neurology
- Stroke Research
Background:
- Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) are potential stroke risk factors.
- Limited data exists on their impact on recurrent stroke risk.
Purpose of the Study:
- To investigate the risk of recurrent cerebrovascular events in patients with PFO and ASA.
- To identify specific cardiac abnormalities associated with increased recurrent stroke risk.
Main Methods:
- A cohort of 581 ischemic stroke patients (age 18-55) with unknown stroke origin were enrolled.
- Patients received aspirin (300 mg/day) for secondary prevention over four years.
- Cardiac abnormalities (PFO, ASA) were assessed for their association with recurrent events.
Main Results:
- The risk of recurrent stroke was 15.2% in patients with both PFO and ASA, versus 4.2% in those with neither.
- The presence of both PFO and ASA significantly predicted increased recurrent stroke risk (HR 4.17).
- Isolated PFO or ASA did not show a significant association with recurrent stroke.
Conclusions:
- Patients with co-existing PFO and ASA after an initial stroke are a high-risk subgroup for recurrence.
- Current preventive strategies, including aspirin, may be insufficient for this population.
- Consideration of alternative preventive strategies is warranted for patients with both PFO and ASA.
Background:
Patent foramen ovale and atrial septal aneurysm have been identified as potential risk factors for stroke, but information about their effect on the risk of recurrent stroke is limited. We studied the risks of recurrent cerebrovascular events associated with these cardiac abnormalities.
Methods:
A total of 581 patients (age, 18 to 55 years) who had had an ischemic stroke of unknown origin within the preceding three months were consecutively enrolled at 30 neurology departments. All patients received aspirin (300 mg per day) for secondary prevention.
Results:
After four years, the risk of recurrent stroke was 2.3 percent (95 percent confidence interval, 0.3 to 4.3 percent) among the patients with patent foramen ovale alone, 15.2 percent (95 percent confidence interval, 1.8 to 28.6 percent) among the patients with both patent foramen ovale and atrial septal aneurysm, and 4.2 percent (95 percent confidence interval, 1.8 to 6.6 percent) among the patients with neither of these cardiac abnormalities. There were no recurrences among the patients with an atrial septal aneurysm alone. The presence of both cardiac abnormalities was a significant predictor of an increased risk of recurrent stroke (hazard ratio for the comparison with the absence of these abnormalities, 4.17; 95 percent confidence interval, 1.47 to 11.84), whereas isolated patent foramen ovale, whether small or large, was not.
Conclusions:
Patients with both patent foramen ovale and atrial septal aneurysm who have had a stroke constitute a subgroup at substantial risk for recurrent stroke, and preventive strategies other than aspirin should be considered.
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