Cardiac and Echocardiographic Markers in Cryptogenic Stroke with Incidental Patent Foramen Ovale

Area of Science:

• Cardiology
• Neurology
• Echocardiography

Background:

• Cryptogenic stroke (CS) may arise from cardiac abnormalities, particularly in patients with incidental patent foramen ovale (PFO).
• The Risk of Paradoxical Embolism (RoPE) score helps stratify stroke risk in PFO patients.
• Identifying specific cardiac and echocardiographic markers associated with CS in PFO is crucial for risk stratification.

Purpose of the Study:

• To evaluate the association between cardiac and echocardiographic markers and cryptogenic stroke (CS) in patients with incidental patent foramen ovale (PFO).
• To determine if these markers correlate with the Risk of Paradoxical Embolism (RoPE) score.

Main Methods:

• A multicenter observational study of 677 cryptogenic stroke patients, with 300 having PFO detected by transesophageal echocardiography.
• Patients were divided into probable PFO-related stroke (RoPE score > 6) and incidental PFO (RoPE score ≤ 6) groups.
• Clinical characteristics, laboratory findings, and echocardiographic markers were compared; logistic regression identified risk factors for low RoPE scores.

Main Results:

• Higher brain natriuretic peptide, left atrial (LA) enlargement, higher E/e', lower LA appendage flow velocity, non-substantial PFO, and aortic arch plaques were associated with lower RoPE scores.
• LA enlargement was an independent predictor of low RoPE scores (adjusted OR, 1.15; 95% CI, 1.00-1.32).
• Patients with higher RoPE scores showed a trend towards excellent outcomes (78% vs. 58%).

Conclusions:

• Abnormal cardiac substrates, including LA enlargement, are associated with cryptogenic stroke in a subset of patients with incidental patent foramen ovale.
• Patients with CS and incidental PFO may be at increased risk for cardioembolic events.
• Echocardiographic markers can aid in identifying patients with PFO who are at higher risk for stroke.