Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors.

Kahles, Timo; Michel, Patrik; Hapfelmeier, Alexander; Eberli, Franz R; Zedde, Marialuisa; Thijs, Vincent; Kraemer, Markus; Engelter, Stefan T; Serena, Joaquin; Weimar, Christian; Mallmann, Achim; Luft, Andreas; Hemelsoet, Dimitri; Thaler, David E; Müller-Eichelberg, Andreas; De Pauw, Adinda; Sztajzel, Roman; Armon, Carmel; Kent, David M; Meier, Bernhard; ... (2020). Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors. Frontiers in neurology, 11(503), p. 503. Frontiers Media S.A. 10.3389/fneur.2020.00503

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Background and Purpose: To identify factors associated with prior stroke at presentation in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO). Methods: We studied cross-sectional data from the International PFO Consortium Study (NCT00859885). Patients with first-ever stroke and those with prior stroke at baseline were analyzed for an association with PFO-related (right-to-left shunt at rest, atrial septal aneurysm, deep venous thrombosis, pulmonary embolism, and Valsalva maneuver) and PFO-unrelated factors (age, gender, BMI, hypertension, diabetes mellitus, hypercholesterolemia, smoking, migraine, coronary artery disease, aortic plaque). A multivariable analysis was used to adjust effect estimation for confounding, e.g., owing to the age-dependent definition of study groups in this cross-sectional study design. Results: We identified 635 patients with first-ever and 53 patients with prior stroke. Age, BMI, hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease, and right-to-left shunt (RLS) at rest were significantly associated with prior stroke. Using a pre-specified multivariable logistic regression model, age (Odds Ratio 1.06), BMI (OR 1.06), hypercholesterolemia (OR 1.90) and RLS at rest (OR 1.88) were strongly associated with prior stroke.Based on these factors, we developed a nomogram to illustrate the strength of the relation of individual factors to prior stroke. Conclusion: In patients with CS and PFO, the likelihood of prior stroke is associated with both, PFO-related and PFO-unrelated factors.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Meier, Bernhard, Mattle, Heinrich, Fischer, Urs Martin, Arnold, Marcel, Mono, Marie-Luise, Nedeltchev, Krassen


600 Technology > 610 Medicine & health




Frontiers Media S.A.




Chantal Kottler

Date Deposited:

11 Nov 2020 12:16

Last Modified:

02 Mar 2023 23:33

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

International PFO Consortium PFO cryptogenic stroke hypercholesterolemia patent foramen ovale prior stroke right-to-left shunt risk factor




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