Clinical Relevance of Patent Foramen Ovale and Atrial Septum Aneurysm in Stroke: Findings of a Single-Center Cross-Sectional Study

Abstract

Background: A significant proportion of ischemic strokes are cryptogenic. In this context, the clinical pertinence of patent foramen ovale (PFO) with and without atrial septum aneurysm (ASA) remains controversial. The aim of this study was to identify how PFO +/–ASA and cryptogenic stroke are associated in a representative sample of stroke patients. Methods: We enrolled all patients (n = 909) with ischemic stroke or transient ischemic attack admitted to the certified stroke unit or neurological intensive care unit of our university medical center who underwent transesophageal echocardiography (TEE) between 2012 and 2014. The baseline characteristics, cardio-/neurovascular risk factors, clinical parameters and TEE findings were analyzed. Results: PFO was present in 26.2%, and PFO was combined with an ASA in 9.9%. In cryptogenic stroke, the prevalence of PFO was higher compared to other etiologies (30.9 vs. 21.9%; p < 0.002). Patients with PFO had lower National Institute of Health Stroke Score (NIHSS) values at admission than those without (2 [0–5] vs. 3 [1–7]; p = 0.001; 95% CI [0.62–0.88]). No difference was found in NIHSS values of PFO patients with or without ASA (2 [0–5] vs. 2 [0–5]; p = 0.683; 95% CI 0.94 [0.68–1.28]). Conclusions: Our study indicates that a detected PFO +/–ASA could exhibit a stroke-relevant finding, if classical risk factors for the stroke were lacking.

Utility of Transesophageal Echocardiography in the Identification and Treatment of Occult Mechanisms of Cerebral Infarction

“…These data are consistent with previously published literature indicating that emboli from these high-risk CSEs (largely PFOs) may be physiologically distinct from emboli due to AF or cervicocephalic atherosclerotic disease. According to several observational studies involving cryptogenic or cardioembolic stroke populations, patients with PFO have generally milder presenting de cits and less frequent intracranial occlusions when compared to patients without PFO, or with other sources of cardiac embolism (e.g., AF) [18][19][20].…”

Utility of Transesophageal Echocardiography in the Identification and Treatment of Occult Mechanisms of Cerebral Infarction (4844)

“…These data are consistent with previously published literature indicating that emboli from these high-risk CSEs (largely PFOs) may be physiologically distinct from emboli due to AF or cervicocephalic atherosclerotic disease. According to several observational studies involving cryptogenic or cardioembolic stroke populations, patients with PFO have generally milder presenting de cits and less frequent intracranial occlusions when compared to patients without PFO, or with other sources of cardiac embolism (e.g., AF) [18][19][20].…”

Intelligent Prediction of Cryptogenic Stroke Using Patent Foramen Ovale from TEE Imaging Data and Machine Learning Methods

“…ASA was defined as ≥ 10 mm of septal excursion from the midline into the right or left atrium, or ≥ 15 mm of the total excursion between the right and left atrium (Fig. 3B) [20]. Maximum mobility was equal to the sum of the excursions (the greatest leftward and rightward deflections of the septum with respect to a line perpendicular to the fossa ovalis plane; Fig.…”