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Relation between patent foramen ovale and unexplained stroke
G Van Camp1, D Schulze, B Cosyns
1Department of Cardiology, Saint-Pierre University Hospital, Bruxelles, Belgium.
Insights
Patent foramen ovale (PFO) may contribute to cryptogenic stroke. Early, massive contrast passage into the left atrium during echocardiography, coupled with abnormal PFO morphology, indicates a higher stroke risk.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Patent foramen ovale (PFO) is a potential, yet debated, cause of cryptogenic stroke.
- Understanding PFO characteristics is crucial for stroke risk stratification.
Purpose of the Study:
- To investigate the relationship between PFO characteristics and unexplained stroke incidence.
- To identify specific PFO features associated with cerebrovascular accidents.
Main Methods:
- Comparative analysis of 29 patients with unexplained stroke and 28 controls.
- Echocardiographic assessment of PFO: timing and magnitude of left atrial contrast, and atrial septum morphology.
Main Results:
- A significant association was found between stroke incidence and early, massive contrast passage in the left atrium (21% vs 0%, p < 0.05).
- Abnormal foramen ovale morphology was more prevalent in patients with PFO (69% vs 2%, p < 0.001).
Conclusions:
- Early and massive contrast passage via PFO, especially with abnormal morphology, suggests a role in cryptogenic stroke.
- Contrast transesophageal echocardiography timing and quantification are valuable for assessing stroke risk in PFO patients.
Abstract:
To better elucidate the possible role of the patent foramen ovale (PFO) in patients with unexplained stroke, the relation between the incidence of stroke and 3 characteristics of PFO (timing, magnitude of appearance of echocardiographic contrast in the left atrium, and morphology of the atrial septum) was analyzed. Twenty-nine patients with unexplained stroke and 28 without stroke were compared. A significant relation was only found between the incidence of cerebrovascular accident and positive contrast echocardiography in patients with early and massive passage of contrast in the left atrium (6 of 29 [21%] in the stroke group vs 0 of 28 [0%] in the control group; p < 0.05). An abnormal morphology of the foramen ovale was found more frequently in patients with PFO than in those without PFO (9 of 13 [69%] vs 1 of 44 [2%]; p < 0.001). The results suggest the use of timing and quantification of contrast appearance in the left atrium during contrast transesophageal echocardiography, and that paradoxical embolism through a PFO is a possible mechanism of cryptogenic stroke only if there is a massive passage of contrast through an abnormal foramen ovale.