Association between Atrial Septal Aneurysm and Patent Foramen ovale in Young Patients with Recent Stroke and Normal Carotid Arteries

Abstract

Background: Atrial septal aneurysm (ASA) has been considered a potential source of cardiogenic embolism for many years. The ASA Multicenter Italian (ASA-MI) Study evaluated the prevalence and characteristics of ASA in patients with stroke and normal carotid arteries compared with control patients without stroke. The purpose of the present study was to evaluate the frequency of ASA and the association with patent foramen ovale (PFO) in the subgroup of younger patients (aged less than 55 years) included in the ASA-MI Study. Methods: The ASA-MI Study included 606 patients, enrolled between November 1990 and December 1996: 245 patients with a previous cerebral embolic attack and normal carotid study and a control group of 316 patients. They all underwent transthoracic and transesophageal echocardiography. The subgroup of younger patients aged less than 55 years included 90 patients (61 men and 29 women of mean age 49 ± 5 years) (group AY). This group was evaluated and compared with an age- and sex-matched control population (61 men; of mean age 48 ± 6 years) (group BY). Results: The prevalence of ASA was 48.8% (95% confidence interval 40–61) in group AY and 22.2% in the group BY (95% confidence interval 18–33) (χ² = 5.968; p = 0.01). Morphological features were similar in the 2 groups of patients. ASA involved the entire septum in 52% of patients of group AY, and in 47.2% of group BY. The prevalence of PFO was 58.8% (95% confidence interval 43–62) in group AY and 28.8% in group BY (95% confidence interval 17–35) (χ² = 5.811; p = 0.01). A strong association was found between ASA and PFO. Of the 90 younger patients with stroke, 39 of 44 (88.6%) with ASA also had PFO, compared with 14 of 46 (30.4%) without ASA (χ² = 7.370; p = 0.007). Conclusion: We found that ASA and PFO were independent predictive factors for stroke in younger patients with stroke and normal carotid arteries and that the association between ASA and PFO bore an increased odds risk.

Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

“…Thyreotoxicosis [22] and some chemyotherapic drugs [23] have been suggested as causes of coronary spasm. Mitral valve prolapse has been found associated with ASA [24] and with sudden death [25] but its cause-effect relationships with myocardial ischemia are still unclear.…”

Stroke in younger patients: the heart of the matter

“…Little is understood of the pathogenesis of these aneurysms. They were initially identified on post-mortem studies as a redundancy of tissue of the septum primum, which bulges DCM Dilated cardiomyopathy, IE infective endocarditis, IHD ischaemic heart disease, including regional wall motion abnormalities into the right or left atrium, usually occurring in association with PFO [38][39][40]. They are now diagnosed with echo and are best seen with TOE (Online Resource 1).There is some discrepancy regarding what constitutes an aneurysmal septum, although it is often defined as a maximum protrusion of [10 mm [41].…”

Stroke Recurrence and its Prevention in Patients with Patent Foramen Ovale

“…The reason to decide for medical therapy in these patients was mainly due to the patients' preference for medical therapy, allowing for self-selection bias. Incidence of an ASA and/or a large shunt -two factors associated with an increased risk of (cryptogenic) stroke according to some studies [34][35][36][37][38] -were more equally distributed between the two groups. We conclude that although the risk profile may have been even slightly higher in the medically treated group (as a result of the non-randomized trial design), this treatment option was as good as catheter-based closure to prevent stroke recurrence.…”