Related Experiment Video
Updated: Oct 8, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Association Between Patent Foramen Ovale and Overt Ischemic Stroke in Children With Sickle Cell Disease
Najibah A Galadanci1, Walter Johnson2, April Carson3
1Division of Hematology and Oncology, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Insights
Patent foramen ovale (PFO) was not significantly associated with overt ischemic stroke in children with sickle cell anemia (SCA). This large study found a lower prevalence of PFO than previously reported in SCA patients.
Area of Science:
- Pediatric Neurology
- Hematology
- Cardiology
Background:
- Ischemic stroke is a severe complication of sickle cell anemia (SCA).
- Intracardiac shunting, specifically patent foramen ovale (PFO), has been implicated as a potential stroke risk factor in children with SCA.
- Previous research suggests a link, but larger cohort studies are needed.
Purpose of the Study:
- To investigate the association between PFO and overt ischemic stroke in a large cohort of children with SCA.
- To assess the relationship between PFO and other clinical factors, including abnormal sickle stroke screen (elevated Transcranial Doppler ultrasound - TCD velocity) and baseline hemoglobin.
- To determine the prevalence of PFO in children with SCA using non-contrast echocardiography.
Main Methods:
- Analysis of the DISPLACE study cohort, including 5,247 children with SCA.
- Inclusion of 1,414 children with at least one clinical non-contrast transthoracic echocardiogram.
- Assessment of PFO presence from clinical reports and correlation with stroke, TCD velocity, and hemoglobin levels in 642 children with complete data.
Main Results:
- The adjusted odds ratio for overt stroke in children with PFO was 1.49, but this was not statistically significant (p = 0.6994).
- PFO was not found to be more common in children with abnormal TCD velocity (OR: 0.85, p = 0.8463).
- The prevalence of PFO in this cohort was lower than reported in smaller studies using bubble contrast echocardiography.
Conclusions:
- PFO was not statistically significantly associated with overt ischemic stroke in children with SCA.
- There was no evidence supporting PFO as a risk factor for abnormal TCD findings in this population.
- The study highlights a lower prevalence of PFO in SCA children compared to prior investigations, suggesting potential differences based on diagnostic methods.
Abstract:
Ischemic stroke is one of the most devastating complications of sickle cell anemia (SCA). Previous studies have shown that intracardiac shunting including patent foramen ovale (PFO) can be a potential risk factor for stroke in children with SCA. This study investigates the association between PFO and overt ischemic stroke in the DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study cohort of 5,247 children with SCA of whom 1,414 had at least one clinical non-contrast transthoracic echocardiogram. Presence of PFO was taken from the clinical report. Further, we assessed the association between PFO and other clinical and hemolytic factors in children with SCA such as history of abnormal sickle stroke screen [elevated Transcranial Doppler ultrasound (TCD) velocity] and patient's baseline hemoglobin. In 642 children for whom all data were available, the adjusted odds ratio (OR) for overt stroke was higher in those with PFO but this was not statistically significant (OR: 1.49, 95% CI: 0.20-11.03, p = 0.6994). With an OR of 0.85, the study suggested less PFOs in those with abnormal TCD, but this was not statistically significant (95% CI: 0.17-4.25, p = 0.8463). Overall, the prevalence of PFO in this large sub study of non-contrast echocardiography amongst children with SCA is much lower than previous smaller studies using bubble contrast echocardiography. Overt stroke was non-statistically more common in children with SCA and PFO, but there was no evidence that PFO was more common in those with abnormal TCD, the most important pediatric sickle stroke screen.
