Characteristics and prognosis of patients with cryptogenic stroke and suggestive of patent foramen ovale

Abstract

Aims The purpose of this study were to identify the usefulness of screening for PFO using agitated saline echocardiography (ASE) and characteristics and prognosis of patients with suggestive of patent foramen ovale (PFO). Methods Three hundred three patients (mean age, 53 ± 9 years; 199 [66%] men) admitted with acute stroke or suspicion of stroke were included. Patients were classified into those with and without right-to-left shunt (RLS) according to the ASE results (positive ASE [n = 92] vs. negative ASE [n = 211]). Fifty-one out of ninety-two patients with positive ASE and twenty-one out of two hundred eleven patients with negative ASE underwent TEE with ASE to confirm PFO. Results Ninety-two were positive for ASE and thirty-six of the fifty-one patients who underwent TEE were confirmed as having PFO. Of the patients with RLS grade 1, 50% were diagnosed with PFO and all patients with RLS grade ≥ 2 were diagnosed with PFO. All patients with negative ASE had no PFO (sensitivity of 100% and specificity of 58%). Patients with positive ASE were younger, had a lower body mass, and a lower prevalence of hypertension. The positive ASE patients had a higher mean Sʹ velocity and better diastolic function. Four of ninety-one patients with positive ASE and thirteen of one hundred seventy-seven showed recurrence of stroke and suspicion of stroke. Conclusion Transthoracic ASE is a good method to screen for PFO. Patients with suggestive of PFO had lower risk factors, less atherosclerosis, and better cardiac performance.

Overcoming a stubborn patent foramen ovale

“…PFO occurs in approximately 25% of the global population and while often clinically insignificant, it may present an increased risk of stroke by allowing shunting of venous emboli directly to the LA 1 . Data estimates that the 4‐year recurrence rate for stroke in patients with PFO is up to 25%, even in spite of standard antiplatelet therapy 2 . Interventional PFO closure may lower the risk of recurrent stroke as compared to those with PFO who receive antiplatelet therapy alone 3 .…”

“…Compared with transthoracic echocardiography (TTE), TEE is the gold standard for evaluation for PFO closure, as it provides anatomical detail superior to that of TTE. Further, contrast echocardiography with agitated saline (“bubble study”) is used within the context of PFO detection to provide optimal visualization of right‐to‐left (R‐L) shunting in suspected PFO 2 . To facilitate R‐L shunting, the American Society of Echocardiography recommends standard provocative measures for increasing the RA pressure sufficiently to sustain the R‐L shunting 4 .…”

“…1 Data estimates that the 4-year recurrence rate for stroke in patients with PFO is up to 25%, even in spite of standard antiplatelet therapy. 2 Interventional PFO closure may lower the risk of recurrent stroke as compared to those with PFO who receive antiplatelet therapy alone. 3 Compared with transthoracic echocardiography (TTE), TEE is the gold standard for evaluation for PFO closure, as it provides anatomical detail superior to that of TTE.…”

Acute neurological deficit with submassive pulmonary emboli

“…While TOE is the gold-standard to diagnose PFO, the procedure requires sedation and is invasive, making it high-risk in acutely unwell patients with PE. However, contemporary evidence including several observational studies and a large meta-analysis suggests that TTE is non-inferior to TOE, and should be considered as the first line imaging modality to confirm PFO 20–23. TCD is another non-invasive imaging modality used to screen for PFO, with a sensitivity of 70% at baseline, and 92% when combined with the valsalva manoeuvre 18.…”

Embolic myocardial infarction associated with patent foramen ovale: a case series

“…Исключение ООО при помощи пузырькового теста является общепризнанной и необходимой частью алгоритма обследования пациентов с криптогенными инсультами [8]. Однако в настоящее время имеется ограниченное количество данных о роли ООО в генезе эмболических событий в других бассейнах: периферические и КА.…”