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Prevalence of atrial septal abnormalities in older patients with cryptogenic ischemic stroke or transient ischemic

M Force1, P Massabuau, V Larrue

  • 1Department of Neurology, Hôpital Rangueil, University of Toulouse, Toulouse 31059, France.

Clinical Neurology and Neurosurgery
|June 7, 2008
PubMed

Insights

The combination of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) is significantly linked to cryptogenic stroke or transient ischemic attack (TIA) in older adults. This finding highlights PFO+ASA as a key risk factor in this demographic.

Area of Science:

  • Cardiology
  • Neurology
  • Geriatrics

Background:

  • Cryptogenic stroke and transient ischemic attack (TIA) represent a significant proportion of cerebrovascular events, particularly in older populations.
  • Atrial septal abnormalities, including patent foramen ovale (PFO) and atrial septal aneurysm (ASA), have been implicated as potential contributors to stroke etiology.

Purpose of the Study:

  • To investigate the association between specific atrial septal abnormalities (PFO, ASA, and their combination PFO+ASA) and the occurrence of cryptogenic stroke or TIA.
  • To evaluate these associations specifically within an aging patient cohort (age 55 years and older).

Main Methods:

  • A cohort of 132 consecutive patients aged 55+ undergoing transesophageal echocardiography (TEE) for stroke/TIA evaluation were analyzed.
  • Prevalence of PFO, ASA, and PFO+ASA was determined and compared between patients with cryptogenic stroke/TIA and those with stroke/TIA of known etiology.
  • Statistical analysis included adjusted odds ratios and confidence intervals to assess the strength of associations.

Main Results:

  • The combined abnormality, PFO+ASA, was significantly more prevalent in patients with cryptogenic stroke/TIA (19%) compared to those with known stroke causes (3%) (adjusted OR, 7.4; 95% CI, 1.4-38.2).
  • No significant differences were observed for isolated PFO or isolated ASA between the groups.
  • The association of PFO+ASA with cryptogenic stroke/TIA was particularly strong in the subgroup of patients aged 75 years and older (OR, 15.0; 95% CI, 1.5-146.7).

Conclusions:

  • The co-occurrence of patent foramen ovale and atrial septal aneurysm (PFO+ASA) is a significant risk factor for cryptogenic stroke or TIA in older individuals.
  • These findings suggest that screening for combined PFO and ASA may be warranted in older patients presenting with unexplained stroke or TIA.
Abstract

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