D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale
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Published on: December 23, 2022
Young Dae Kim, Dongbeom Song, Hyo Suk Nam
1Ji Hoe Heo, MD, PhD, Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752, Korea, Tel.: +82 2 2228 1605, Fax: +82 2 393 0705,
Abstract:
Patent foramen ovale (PFO) is a potential cause of cryptogenic stroke, given the possibility of paradoxical embolism from venous to systemic circulation. D-dimer level is used to screen venous thrombosis. We investigated the risk of embolism and mortality according to the presence of PFO and D-dimer levels in cryptogenic stroke patients. A total of 570 first-ever cryptogenic stroke patients who underwent transesophageal echocardiography were included in this study. D-dimer was assessed using latex agglutination assay during admission. The association of long-term outcomes with the presence of PFO and D-dimer levels was investigated. PFO was detected in 241 patients (42.3 %). During a mean 34.0 ± 22.8 months of follow-up, all-cause death occurred in 58 (10.2 %) patients, ischaemic stroke in 33 (5.8 %), and pulmonary thromboembolism in 6 (1.1 %). Multivariate Cox regression analysis showed that a D-dimer level of > 1,000 ng/ml was an independent predictor for recurrent ischaemic stroke in patients with PFO (hazard ratio 5.341, 95 % confidence interval 1.648-17.309, p=0.005), but not in those without PFO. However, in patients without PFO, a D-dimer level of > 1,000 ng/ml was independently related with all-cause mortality. The risk of pulmonary thromboembolism tended to be high in patients with high D-dimer levels, regardless of PFO. Elevated D-dimer levels in cryptogenic stroke were predictive of the long-term outcome, which differed according to the presence of PFO. The coexistence of PFO and a high D-dimer level increased the risk of recurrent ischaemic stroke. The D-dimer test in cryptogenic stroke patients may be useful for predicting outcomes and deciding treatment strategy.
Insights
Elevated D-dimer levels in cryptogenic stroke patients predict outcomes, with higher risks of recurrent stroke in those with a patent foramen ovale (PFO). High D-dimer also predicts mortality in patients without PFO.
Area of Science:
- Cardiology
- Neurology
- Hematology
Background:
- Patent foramen ovale (PFO) is a potential cause of cryptogenic stroke due to paradoxical embolism.
- D-dimer levels are used to screen for venous thrombosis and may indicate embolic risk.
Purpose of the Study:
- To investigate the association between PFO, D-dimer levels, and long-term outcomes in cryptogenic stroke patients.
- To determine if D-dimer levels predict recurrent stroke, mortality, or pulmonary thromboembolism in this population.
Main Methods:
- Retrospective analysis of 570 first-ever cryptogenic stroke patients.
- Transesophageal echocardiography for PFO detection and D-dimer assessment via latex agglutination assay.
- Multivariate Cox regression analysis for long-term outcome prediction (mean follow-up 34.0 months).
Main Results:
- PFO was present in 42.3% of patients.
- D-dimer > 1,000 ng/ml independently predicted recurrent ischemic stroke in patients with PFO (HR 5.341, p=0.005).
- In patients without PFO, D-dimer > 1,000 ng/ml independently predicted all-cause mortality. Pulmonary thromboembolism risk increased with high D-dimer, irrespective of PFO.
Conclusions:
- Elevated D-dimer levels predict long-term outcomes in cryptogenic stroke, with differential effects based on PFO presence.
- Coexistence of PFO and high D-dimer significantly increases recurrent ischemic stroke risk.
- D-dimer testing aids in outcome prediction and treatment strategy for cryptogenic stroke patients.
