Comparison of atrial septal defect and patent foramen ovale in cryptogenic strokes.
Détails
ID Serval
serval:BIB_60CB32C2CB92
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Comparison of atrial septal defect and patent foramen ovale in cryptogenic strokes.
Périodique
Journal of stroke and cerebrovascular diseases
ISSN
1532-8511 (Electronic)
ISSN-L
1052-3057
Statut éditorial
Publié
Date de publication
06/2024
Peer-reviewed
Oui
Volume
33
Numéro
6
Pages
107664
Langue
anglais
Notes
Publication types: Journal Article ; Comparative Study
Publication Status: ppublish
Publication Status: ppublish
Résumé
Paradoxical embolism from right-to-left shunt through atrial septal defect (ASD) and patent foramen ovale (PFO) is a well-accepted cause of "cryptogenic" strokes (CS). To better understand the pathogenic role of ASD, we compared ASD patients with CS having a high and low likelihood of being PFO-related.
In the Acute Stroke Registry and Analysis of Lausanne, we calculated prevalence of PFO and ASD in CS patients undergoing echocardiography, and calculated odds ratios (OR) when compared to non-CS. Using the Risk of Paradoxical Embolism (RoPE) score, we divided CS PFO patients in high (HL-PFO, RoPE 8-10) and low-likelihood (LL-PFO, RoPE 0-4) PFO-related stroke. We then performed univariate comparison of epidemiological, clinical and radiological variables of ASD patients with both PFO groups.
Among all CS, prevalence of ASD and PFO were 1.3% and 36.8% respectively. When compared to non-CS, ASD and PFO were associated with CS (OR of 5.2, CI= 1.6-16.6, and 2.8, CI= 2.1-3.8). Compared with HL-PFO, ASD patients were older, more often female, had more cardiovascular risk factors and silent strokes. Compared with LL-PFO, ASD patients were younger, more often female, and had less risk factors. No differences were found for clinical and radiological characteristics and clinical outcome.
ASD is a rare stroke risk factor for CS. Since characteristics of such patients lie in-between high and low-likelihood paradoxical PFO-strokes, a thorough work-up for other stroke mechanisms is warranted. Individual evaluation of the likelihood of the ASD being causative for stroke may be preferable over routine ASD closure.
In the Acute Stroke Registry and Analysis of Lausanne, we calculated prevalence of PFO and ASD in CS patients undergoing echocardiography, and calculated odds ratios (OR) when compared to non-CS. Using the Risk of Paradoxical Embolism (RoPE) score, we divided CS PFO patients in high (HL-PFO, RoPE 8-10) and low-likelihood (LL-PFO, RoPE 0-4) PFO-related stroke. We then performed univariate comparison of epidemiological, clinical and radiological variables of ASD patients with both PFO groups.
Among all CS, prevalence of ASD and PFO were 1.3% and 36.8% respectively. When compared to non-CS, ASD and PFO were associated with CS (OR of 5.2, CI= 1.6-16.6, and 2.8, CI= 2.1-3.8). Compared with HL-PFO, ASD patients were older, more often female, had more cardiovascular risk factors and silent strokes. Compared with LL-PFO, ASD patients were younger, more often female, and had less risk factors. No differences were found for clinical and radiological characteristics and clinical outcome.
ASD is a rare stroke risk factor for CS. Since characteristics of such patients lie in-between high and low-likelihood paradoxical PFO-strokes, a thorough work-up for other stroke mechanisms is warranted. Individual evaluation of the likelihood of the ASD being causative for stroke may be preferable over routine ASD closure.
Mots-clé
Humans, Foramen Ovale, Patent/diagnostic imaging, Foramen Ovale, Patent/complications, Foramen Ovale, Patent/epidemiology, Female, Male, Heart Septal Defects, Atrial/diagnostic imaging, Heart Septal Defects, Atrial/epidemiology, Heart Septal Defects, Atrial/complications, Risk Factors, Middle Aged, Prevalence, Aged, Registries, Embolism, Paradoxical/epidemiology, Embolism, Paradoxical/diagnostic imaging, Embolism, Paradoxical/etiology, Risk Assessment, Adult, Stroke/epidemiology, Stroke/etiology, Stroke/diagnosis, Stroke/diagnostic imaging, Atrial septal defect, Cryptogenic stroke, Paradoxical embolism, Patent foramen ovale
Pubmed
Web of science
Open Access
Oui
Création de la notice
08/03/2024 16:18
Dernière modification de la notice
25/05/2024 7:12