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Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study
Irene Meissner1, Bijoy K Khandheria, John A Heit
1Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA. meissner.irene@mayo.edu
Journal of the American College of Cardiology
|January 18, 2006
Summary
Patent foramen ovale (PFO) is not an independent stroke risk factor in the general population. Atrial septal aneurysm (ASA) may increase cerebrovascular event risk, warranting further investigation.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Epidemiology
Background:
- The link between patent foramen ovale (PFO) and stroke is debated due to methodological limitations in previous studies.
- Studies often suffer from invalid controls, unblinded assessments, and unadjusted data for age or comorbidities.
Purpose of the Study:
- To prospectively investigate the association between PFO, atrial septal aneurysm (ASA), and stroke in an unselected population.
- To address methodologic weaknesses in prior research on PFO and stroke risk.
Main Methods:
- Transesophageal echocardiography was used to identify PFO in 585 randomly sampled subjects aged 45+ in Olmsted County, MN.
- Standardized definitions and a single echocardiographer ensured consistency.
- Participants were part of the Stroke Prevention: Assessment of Risk in a Community (SPARC) study.
Main Results:
- PFO was found in 24.3% of subjects, and ASA in 1.9%.
- After adjusting for age and comorbidity, PFO was not a significant independent predictor of stroke (HR 1.46, p=0.28).
- Subjects with ASA showed a trend towards increased cerebrovascular event risk (HR 3.72, p=0.074).
Conclusions:
- Prospective, population-based data suggest PFO is not an independent risk factor for future cerebrovascular events after accounting for age and comorbidity.
- Further research is needed to confirm the potential stroke risk associated with ASA.