Ischaemic Stroke and the Echocardiographic “Bubble Study”: Are We Screening the Right Patients?

Maggiore, P.; Bellinge, J.; Chieng, David; White, David; Lan, N.; Jaltotage, Biyanka; Ali, Umar; Gordon, M.; Chung, Kyungsoon; Stobie, Paul; Ng, Justin; Hankey, Graeme J.; McQuillan, Brendan

doi:10.1016/j.hlc.2018.07.007

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…CS comprises 15-40% of all ischemic strokes, and PFO occurs in 40-56% in patients <55 years old with CS or transient ischemic attack (TIA) (6,12,14). One has to distinguish between PFO being a direct cause of stroke and PFO being a risk factor for stroke.…”

Section: Pfo and Strokementioning

confidence: 99%

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Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

Ioannidis

Mitsias

2020

Front. Neurol.

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Patent foramen ovale (PFO) has been associated with cryptogenic stroke. There is conflicting data and it remains uncertain whether PFO is the direct cause, a risk factor or an incidental finding. Potential stroke mechanisms include paradoxical embolism from a venous clot which traverses the PFO, in situ clot formation within the PFO, and atrial arrhythmias due to electrical signaling disruption. Main risk factors linked with PFO-attributable strokes are young age, PFO size, right-to-left shunt degree, PFO morphology, presence of atrial septal aneurysm, intrinsic coagulation-anticoagulation systems imbalance, and coexistence of other atrial abnormalities, such as right atrial septal pouch, Eustachian valve and Chiari's network. These may act independently or synergistically, multiplying the risk of embolic events. The RoPE score, a scale that includes factors such as young age, cortical infarct location and absence of traditional stroke risk factors, is associated with the probability of a PFO being pathogenic and stroke recurrence risk after the index stroke. Multiple investigators have attempted to correlate other PFO features with the risk of PFO-related stroke, but further investigation is needed before any robust conclusions are reached. PFO presence in young patients with cryptogenic stroke should be considered as etiologically suspect. Caution should be exercised in interpreting the relevance of other PFO features.

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Section: Pfo and Strokementioning

confidence: 99%

“…On the other hand, many PFOs in stroke patients represent incidental findings (11). Thus, it is essential to determine the high risk features of PFOs, as only PFO-related CS patients will potentially benefit from a PFO-closure procedure (6,12,13).…”

Section: Introductionmentioning

confidence: 99%

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

Ioannidis

Mitsias

2020

Front. Neurol.

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“…However, TEE requires an expert echocardiographer and is poorly tolerated by patients (more than 40% patients refused TEE in our hospital). In addition, Maggiore, P et al published an article concerns about TEE with bubble study and the need to diagnose PFO in patients with ischemic stroke [ 7 ]. Transcranial Doppler (TCD) might be an alternative method to overcome these limitations of TEE [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

Choi

Kang

Jun

et al. 2021

Cardiovasc Ultrasound

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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.

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Advances in Cardiac Workup for Transient Ischemic Attack: Improving Diagnostic Yield and Reducing Recurrent Stroke Risk

Al-sabbagh,

Thirunavukkarasu,

Eswaradass

2023

Cardiology in Review

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Transient ischemic attack (TIA) is a warning sign for an impending stroke, with a 10–20% chance of a stroke occurring within 90 days of the initial event. Current clinical practice for cardiac workup in TIA includes cardiac enzymes, with 12-lead electrocardiogram, transthoracic echocardiography, and 24-hour Holter monitoring. However, the diagnostic yield of these investigations is variable, and there is a need for better diagnostic approaches to increase the detection of cardiac abnormalities in a cost-effective way. This review article examines the latest research on emerging diagnostic tools and strategies and discusses the potential benefits and challenges of using these advanced diagnostic approaches in clinical practice. Novel biomarkers, imaging techniques, and prolonged rhythm monitoring devices have shown great promise in enhancing the diagnostic yield of cardiac workup in TIA patients. Echocardiography, Transcranial Doppler ultrasound, cardiac MRI, and cardiac CT are among the promising diagnostic tools being studied. We conclude the article with a suggested diagnostic algorithm for cardiac workup in TIA. Further research is necessary to enhance their usefulness and to outline future directions for research and clinical practice in this field.

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Ischaemic Stroke and the Echocardiographic “Bubble Study”: Are We Screening the Right Patients?

Cited by 3 publications

References 33 publications

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

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

Advances in Cardiac Workup for Transient Ischemic Attack: Improving Diagnostic Yield and Reducing Recurrent Stroke Risk

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