Recurrent stroke predictors differ in medically treated patients with pathogenic vs other PFOs

Thaler, David E.; Ruthazer, Robin; Weimar, Christian; Mas, Jean-Louis; Serena, Joaquín; Di Angelantonio, Emanuele; Papetti, Federica; Homma, Shunichi; Mattle, Heinrich P.; Nedeltchev, Krassen; Mono, Marie-Luise; Jaigobin, Cheryl; Michel, Patrik; Elkind, Mitchell S.V.; Di Tullio, Marco R.; Lutz, Jennifer S.; Griffith, John; Kent, David M. (2014). Recurrent stroke predictors differ in medically treated patients with pathogenic vs other PFOs. Neurology, 83(3), pp. 221-226. Lippincott Williams & Wilkins 10.1212/WNL.0000000000000589

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OBJECTIVE: To examine predictors of stroke recurrence in patients with a high vs a low likelihood of having an incidental patent foramen ovale (PFO) as defined by the Risk of Paradoxical Embolism (RoPE) score.METHODS: Patients in the RoPE database with cryptogenic stroke (CS) and PFO were classified as having a probable PFO-related stroke (RoPE score of >6, n = 647) and others (RoPE score of </=6 points, n = 677). We tested 15 clinical, 5 radiologic, and 3 echocardiographic variables for associations with stroke recurrence using Cox survival models with component database as a stratification factor. An interaction with RoPE score was checked for the variables that were significant.RESULTS: Follow-up was available for 92%, 79%, and 57% at 1, 2, and 3 years. Overall, a higher recurrence risk was associated with an index TIA. For all other predictors, effects were significantly different in the 2 RoPE score categories. For the low RoPE score group, but not the high RoPE score group, older age and antiplatelet (vs warfarin) treatment predicted recurrence. Conversely, echocardiographic features (septal hypermobility and a small shunt) and a prior (clinical) stroke/TIA were significant predictors in the high but not low RoPE score group.CONCLUSION: Predictors of recurrence differ when PFO relatedness is classified by the RoPE score, suggesting that patients with CS and PFO form a heterogeneous group with different stroke mechanisms. Echocardiographic features were only associated with recurrence in the high RoPE score group.

Item Type:

Journal Article (Original Article)


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

UniBE Contributor:

Mattle, Heinrich; Nedeltchev, Krassen and Mono, Marie-Luise


600 Technology > 610 Medicine & health




Lippincott Williams & Wilkins




Valentina Rossetti

Date Deposited:

12 Sep 2014 09:27

Last Modified:

13 Jun 2015 02:30

Publisher DOI:


PubMed ID:





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