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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
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Potential Embolic Sources in Embolic Stroke of Undetermined Source Patients with Patent Foramen Ovale

Keith Zhi Xian Toh1, Ming Yi Koh2, Jamie S Y Ho3

  • 1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, ktoh015@e.ntu.edu.sg.

Cerebrovascular Diseases (Basel, Switzerland)
|December 1, 2022
PubMed

Insights

Nearly half of embolic stroke of undetermined source (ESUS) patients with a patent foramen ovale (PFO) also have other potential embolic sources (PESs). Older age and lower Risk of Paradoxical Embolism (RoPE) scores predict these additional sources.

Area of Science:

  • Cardiology
  • Neurology
  • Stroke Medicine

Background:

  • Patent foramen ovale (PFO) is a common finding in patients with embolic stroke of undetermined source (ESUS).
  • The coexistence of PFO with other potential embolic sources (PESs) complicates stroke etiology determination.
  • Identifying concomitant PESs in ESUS patients with PFO is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To determine the prevalence of concomitant potential embolic sources (PESs) in patients with embolic stroke of undetermined source (ESUS) and a patent foramen ovale (PFO).
  • To identify predictors associated with the presence of additional PESs in this patient cohort.

Main Methods:

  • Retrospective cohort study of ESUS patients with PFO admitted between 2012 and 2021.
  • Data collected included baseline characteristics, stroke workup investigations (echocardiography, neuroimaging).
  • Potential embolic sources (PESs) were adjudicated by two independent neurologists.

Main Results:

  • Out of 309 ESUS patients with PFO, 49.8% had only PFO, while 50.2% had one or more additional PESs.
  • The most common additional PESs included atrial cardiopathy (23.9%), left ventricular dysfunction (22.0%), and cardiac valve disease (12.9%).
  • Concomitant PESs were associated with older age (≥60 years), lower Risk of Paradoxical Embolism (RoPE) scores (≤6), and comorbidities like diabetes, hypertension, and ischemic heart disease.

Conclusions:

  • A significant proportion of ESUS patients with PFO also present with concomitant PESs.
  • Older age and lower RoPE scores are predictors for the presence of additional embolic sources in ESUS patients with PFO.
  • Further large-scale studies are needed to clarify the clinical significance of coexisting PESs and PFOs in ESUS.
Abstract

Keywords:
Embolic stroke of undetermined sourcePatent foramen ovalePotential embolic sourcesStroke

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