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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
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An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke

David M Kent1, Robin Ruthazer, Christian Weimar

  • 1Institute for Clinical Research and Health Policy Studies, Tufts Medical Center/Tufts University School of Medicine, Boston, MA, USA. Dkent1@tuftsmedicalcenter.org

Neurology
|July 19, 2013
PubMed

Insights

A new Risk of Paradoxical Embolism score helps stratify cryptogenic stroke (CS) patients with patent foramen ovale (PFO). Higher scores indicate a greater likelihood of stroke being PFO-related and a lower risk of recurrence.

Area of Science:

  • Neurology
  • Cardiology
  • Stroke Medicine

Background:

  • Cryptogenic stroke (CS) is a stroke of unknown origin.
  • Patent foramen ovale (PFO) is a common cardiac finding in CS patients, but its causal role is debated.
  • Stratifying CS patients with PFO is crucial for determining stroke etiology and guiding treatment.

Purpose of the Study:

  • To develop and validate an index to stratify CS patients with PFO based on the likelihood of PFO being the cause of stroke.
  • To estimate PFO-attributable stroke fractions and recurrence rates across different risk strata.

Main Methods:

  • Utilized data from 12 studies involving CS patients with PFO.
  • Employed generalized linear mixed models to identify predictors of PFO in CS.
  • Derived a 10-point Risk of Paradoxical Embolism (RoPE) score based on clinical and imaging variables.

Main Results:

  • Key predictors for PFO in CS included younger age, cortical stroke, and absence of diabetes, hypertension, smoking, and prior stroke/TIA.
  • PFO prevalence increased from 23% in low-RoPE score groups to 73% in high-RoPE score groups.
  • Estimated PFO-attributable stroke fractions ranged from approximately 0% to 90%.
  • Two-year stroke/TIA recurrence rates decreased from 20% in the lowest RoPE score stratum to 2% in the highest.

Conclusions:

  • Clinical characteristics effectively stratify CS patients with PFO by the probability of stroke being PFO-related.
  • The RoPE score identifies patients with a higher likelihood of PFO-related stroke.
  • Patients with higher RoPE scores, indicating a more likely PFO-related stroke, exhibit a lower risk of recurrent stroke.
Abstract

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