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Published on: December 23, 2022
Aortic root dilatation in PFO-related cryptogenic stroke: A propensity score-matched analysis
Christophe Beyls1, Yohann Bohbot2, Bourgain Marion2
1Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France.
Background:
Dilatation of the ascending aorta has an important role in the anatomical conformation of interatrial septum (IAS) especially when a patent foramen ovale (PFO) is present. The aim of the study was to investigate the relationship between ascending aortic dilation and PFO-related cryptogenic stroke in a cohort of cryptogenic strokes.
Methods:
It is a retrospective, single-center echocardiographic study assessing aortic root dilatation in 315 consecutive patients with cryptogenic stroke between January 2011 and January 2019. Aortic root dilatation was defined by a diameter of the Valsalva sinuses of the proximal aorta >40 mm. Predictive factors of PFO were assessed by a multivariate analysis. Propensity score matching was applied to account for clinical differences.
Results:
Of the 315 patients, 68 (22%) had an aortic root dilatation and 167 (53%) had a PFO. In the aortic root dilation group, PFO was more often diagnosed (n = 47/68 [69%], vs n = 120/247 [49%], P = .004). In the PFO group with aortic dilatation, IAS was more mobile (n = 37/47[79%] vs n = 69/120[57%], P < .012) and smaller (2.3 ± 0.5 vs 2.5 ± 0.5 mm, P < .009). On multivariate analysis, aortic root dilatation (OR: 2.6; 95% CI [1.2-5.6]; P = .001) and IAS hypermobility (OR: 5.2 95% CI [2.7-10]; P = .001) were associated with PFO. After propensity matching, aortic root dilatation remained strongly associated with PFO (n = 34/107 [32%] vs 15/107[14%], P = .002).
Conclusion:
Aortic root dilation and IAS hypermobility were strongly associated with PFO-related cryptogenic stroke.
Insights
Aortic root dilation is linked to patent foramen ovale (PFO)-related cryptogenic stroke. Interatrial septum hypermobility also strongly predicts PFO in these patients.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Ascending aortic dilation influences interatrial septum (IAS) anatomy, particularly with patent foramen ovale (PFO).
- Cryptogenic stroke, a stroke of unknown origin, is a significant clinical concern.
- The relationship between aortic dilation and PFO in cryptogenic stroke requires further investigation.
Purpose of the Study:
- To investigate the association between ascending aortic dilation and patent foramen ovale (PFO)-related cryptogenic stroke.
- To identify predictive factors for PFO in patients with cryptogenic stroke.
- To assess the role of aortic root diameter and IAS mobility in cryptogenic stroke etiology.
Main Methods:
- Retrospective, single-center echocardiographic study of 315 cryptogenic stroke patients (Jan 2011-Jan 2019).
- Aortic root dilation defined as Valsalva sinuses diameter >40 mm.
- Multivariate analysis and propensity score matching were used to assess PFO predictors and associations.
Main Results:
- Aortic root dilation was present in 22% of patients; PFO in 53%.
- Aortic root dilation was significantly associated with PFO (69% vs 49%, P=.004).
- IAS hypermobility (79% vs 57%, P<.012) and smaller IAS dimensions were noted in patients with both aortic dilation and PFO. Aortic root dilation (OR: 2.6) and IAS hypermobility (OR: 5.2) were independent predictors of PFO.
Conclusions:
- Aortic root dilation and IAS hypermobility are strongly associated with PFO-related cryptogenic stroke.
- These findings highlight the importance of evaluating aortic root dimensions in cryptogenic stroke patients with suspected PFO.
- Echocardiography plays a crucial role in identifying anatomical factors contributing to stroke risk.
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