Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale: analysis of putative high-risk features from the risk of paradoxical embolism database

Wessler, Benjamin S.; Thaler, David E.; Ruthazer, Robin; Weimar, Christian; Di Tullio, Marco R.; Elkind, Mitchell S. V.; Homma, Shunichi; Lutz, Jennifer S.; Mas, Jean-Louis; Mattle, Heinrich P.; Meier, Bernhard; Nedeltchev, Krassen; Papetti, Federica; Di Angelantonio, Emanuele; Reisman, Mark; Serena, Joaquín; Kent, David M. (2014). Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale: analysis of putative high-risk features from the risk of paradoxical embolism database. Circulation. Cardiovascular Imaging, 7(1), pp. 125-131. Lippincott Williams & Wilkins 10.1161/CIRCIMAGING.113.000807

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BACKGROUND Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS), although the pathogenicity of a discovered PFO in the setting of CS is typically unclear. Transesophageal echocardiography features such as PFO size, associated hypermobile septum, and presence of a right-to-left shunt at rest have all been proposed as markers of risk. The association of these transesophageal echocardiography features with other markers of pathogenicity has not been examined. METHODS AND RESULTS We used a recently derived score based on clinical and neuroimaging features to stratify patients with PFO and CS by the probability that their stroke is PFO-attributable. We examined whether high-risk transesophageal echocardiography features are seen more frequently in patients more likely to have had a PFO-attributable stroke (n=637) compared with those less likely to have a PFO-attributable stroke (n=657). Large physiologic shunt size was not more frequently seen among those with probable PFO-attributable strokes (odds ratio [OR], 0.92; P=0.53). The presence of neither a hypermobile septum nor a right-to-left shunt at rest was detected more often in those with a probable PFO-attributable stroke (OR, 0.80; P=0.45; OR, 1.15; P=0.11, respectively). CONCLUSIONS We found no evidence that the proposed transesophageal echocardiography risk markers of large PFO size, hypermobile septum, and presence of right-to-left shunt at rest are associated with clinical features suggesting that a CS is PFO-attributable. Additional tools to describe PFOs may be useful in helping to determine whether an observed PFO is incidental or pathogenically related to CS.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Mattle, Heinrich; Meier, Bernhard and Nedeltchev, Krassen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1942-0080

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

12 Sep 2014 09:31

Last Modified:

29 Oct 2015 13:00

Publisher DOI:

10.1161/CIRCIMAGING.113.000807

PubMed ID:

24214884

Uncontrolled Keywords:

cardiovascular imaging cerebrovascular disease/stroke congenital heart disease echocardiography foramen ovale, patent risk factor

BORIS DOI:

10.7892/boris.44966

URI:

https://boris.unibe.ch/id/eprint/44966

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