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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale
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.
