Left Atrial Dysfunction in Patients With Patent Foramen Ovale and Atrial Septal Aneurysm

Rigatelli, Gianluca; Aggio, Silvio; Cardaioli, Paolo; Braggion, Gabriele; Giordan, Massimo; Dell’Avvocata, Fabio; Chinaglia, Mauro; Rigatelli, Gianluca; Roncon, Loris; Chen, Jack P.

doi:10.1016/j.jcin.2009.05.010

Cited by 97 publications

(77 citation statements)

References 21 publications

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“…For example, left atrial dysfunction can occur in patients with a patent foramen ovale. 8 Patent foramen ovale (not assessed in the study by Bouzas-Mosquera and colleagues) is found more commonly in patients with cryptogenic stroke than in those with no history of stroke or in those who have stroke of determined cause. 9 Paradoxical embolism through a patent foramen ovale may be important in the pathophysiology of acute stroke in patients with deep vein thrombosis, a relatively rare event.…”

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confidence: 97%

Left atrial enlargement: A cause of stroke?

Goldstein¹

2011

Canadian Medical Association Journal

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A lthough there are a variety of established risk factors for ischemic stroke and its common pathophysiologies are well known, a specific cause remains undefined in 25%-40% of instances. That rate is influenced in part by the thoroughness of the poststroke evaluation.1 A cause, however, can remain undetermined in up to 12% of patients having an acute event, even with a full diagnostic assessment. 2At least part of the diagnostic uncertainty can be related to the impact of relatively unrecognized risk factors. For example, the most widely used stroke risk assessment tool, the Framingham stroke risk profile, includes the following wellrecognized stroke risk factors: age, systolic blood pressure, use of antihypertensive medications, diabetes mellitus, smoking, having cardiovascular disease, atrial fibrillation and left ventricular hypertrophy on electrocardiography.3 Although this tool is useful, many people have strokes despite a low Framingham stroke risk profile score, which does not incorporate a variety of less established risk factors. In this week's CMAJ, Bouzas-Mosquera and colleagues 4 describe an independent, graded association between left atrial size on electrocardiography and stroke risk in women but not in men. Prior studies reported a similar relation between left atrial size and ischemic stroke risk in men, but not in women. 5,6 The reason for the discrepancy among these studies is uncertain, and the findings need to be validated through replication in other patient populations. Bouzas-Mosquera and coauthors posit that the variability among reports might be a result of differences in study populations. Another possibility is that left atrial enlargement is a risk marker that only indirectly reflects one or a combination of risk factors. For example, left atrial enlargement is associated with an increased risk of atrial fibrillation, 7 which is a major stroke risk factor that may become apparent only with prolonged and repeated cardiac monitoring.Left atrial enlargement also might be a marker for other conditions that could increase stroke risk. For example, left atrial dysfunction can occur in patients with a patent foramen ovale. Patent foramen ovale (not assessed in the study by Bouzas-Mosquera and colleagues) is found more commonly in patients with cryptogenic stroke than in those with no history of stroke or in those who have stroke of determined cause. 9Paradoxical embolism through a patent foramen ovale may be important in the pathophysiology of acute stroke in patients with deep vein thrombosis, a relatively rare event.The role of patent foramen ovale in patients without a source of embolism is less certain. There is no difference in the rate of recurrent stroke between groups of patients with otherwise cryptogenic stroke who do or do not have a patent foramen ovale, regardless of the type of medical treatment (antiplatelet medication v. anticoagulation). One randomized trial with results reported in abstract form (CLOSURE-1, 2011 International Stroke Conference) found no difference in the ...

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confidence: 97%

Left atrial enlargement: A cause of stroke?

Goldstein¹

2011

Canadian Medical Association Journal

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“…Rigatelli et al [3], in a study of 98 patients with ASA, found that LA dysfunction was higher in the patient groups.…”

Section: Discussionmentioning

confidence: 94%

“…Despite prior reports concerning paradoxical embolism through a PFO, the magnitude of this phenomenon as a risk factor for a stroke remains undefined because deep venous thrombosis is infrequently detected in such patients. Atrial dysfunction and atrial arrhythmia, such as atrial fibrillation (AF), might represent an alternate and additional mechanism for arterial embolism in these patients [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Left atrial mechanical function and stiffness in patients with atrial septal aneurysm: A speckle tracking study

2015

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“…47,48 The LA functions of PFO patients were reportedly lower than normal, similar to patients with AF. 49 In addition, increased incidence of interatrial block due to stretching of the interatrial septum was reported in patients with ESUS and PFO, suggesting that atrial arrhythmia might underlie and mediate thrombus formation. 50 Because atrial dysfunction and concomitant AF have been suggested as a mechanism of stroke related to PFO, 49,50 longer electrocardiogram monitoring should be considered for patients with larger infarcts or echocardiographic findings of LA dysfunction.…”

Section: Prevention Of Stroke In Patients With Pforelated Strokementioning

confidence: 99%

“…Using intraprocedural intracardiac echocardiographic assessment in candidates for PFO closure, Rigatelli and colleagues demonstrated that ASA were associated with LA dysfunction, and spontaneous echocontrast was observed in 52% of ASA. 49 This may be true for patients without ASA. Recently, reports about the association between LA abnormality and cryptogenic stroke have been increasing.…”

Section: Prevention Of Stroke In Patients With Pforelated Strokementioning

confidence: 99%

A Case Report of Integrative Treatment with Conventional and Korean Medicine Applied to a Patient with Cerebral Infarction Due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale

김¹,

옥²,

양³

et al. 2016

J Int Korean Med

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Patent foramen ovale (PFO) is growing in clinical interest because of a renewed focus on embolic stroke of undetermined source (ESUS), the PFO attributable fraction (the 10-point Risk of Paradoxical Embolism score), technical advances in PFO diagnosis, and the emergence of endovascular device closure as a treatment option. However, recent randomized controlled trials of the management of patients with ESUS and PFO failed to demonstrate the superiority of closure over medical treatment. The mechanisms of stroke other than paradoxical embolism may be important in patients with ESUS and PFO. This paper reviews the current understanding of the pathophysiology of stroke and therapeutic options in patients with PFO and ESUS.

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Left Atrial Dysfunction in Patients With Patent Foramen Ovale and Atrial Septal Aneurysm

Abstract: This study suggests that moderate-to-severe ASA might be associated with LA dysfunction in patients with PFO. The resultant similarities to the pathophysiology of AF might represent an additional contributing mechanism for arterial embolism in such patients.

Cited by 97 publications

References 21 publications

Left atrial enlargement: A cause of stroke?

Left atrial enlargement: A cause of stroke?

Left atrial mechanical function and stiffness in patients with atrial septal aneurysm: A speckle tracking study

A Case Report of Integrative Treatment with Conventional and Korean Medicine Applied to a Patient with Cerebral Infarction Due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale

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