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Patent foramen ovale and cryptogenic stroke in older patients

Michael Handke1, Andreas Harloff, Manfred Olschewski

  • 1Department of Cardiology, University Hospital Freiburg, Freiburg, Germany. handkem@uhbs.ch

The New England Journal of Medicine
|November 30, 2007
PubMed

Insights

Patent foramen ovale is linked to cryptogenic stroke in both younger and older adults. This finding suggests paradoxical embolism may cause stroke across all age groups.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Previous studies linked patent foramen ovale (PFO) to cryptogenic stroke in patients under 55.
  • The association between PFO and cryptogenic stroke in older adults (≥55 years) remained unclear.

Purpose of the Study:

  • To investigate the association between PFO and cryptogenic stroke in both younger and older patients.
  • To determine if PFO with atrial septal aneurysm increases stroke risk in different age groups.

Main Methods:

  • Prospective study of 503 stroke patients (227 cryptogenic, 276 known cause).
  • Transesophageal echocardiography used to assess PFO prevalence.
  • Comparison of PFO prevalence in patients <55 years and ≥55 years.

Main Results:

  • PFO prevalence was significantly higher in cryptogenic stroke patients than in controls for both younger (43.9% vs 14.3%) and older (28.3% vs 11.9%) groups.
  • PFO with atrial septal aneurysm showed a stronger association with cryptogenic stroke in both age groups.
  • Multivariate analysis confirmed PFO as an independent predictor of cryptogenic stroke in both younger (OR 3.70) and older (OR 3.00) patients.

Conclusions:

  • A significant association exists between PFO and cryptogenic stroke in both younger and older patient populations.
  • These findings support paradoxical embolism as a potential cause of stroke across a wide age range.
Abstract

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