Aortic root dilatation in PFO-related cryptogenic stroke: A propensity score-matched analysis

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.