David E Thaler1, Robin Ruthazer2, Christian Weimar2, Jean-Louis Mas2, Joaquín Serena2, Emanuele Di Angelantonio2, Federica Papetti2, Shunichi Homma2, Heinrich P Mattle2, Krassen Nedeltchev2, Marie-Luise Mono2, Cheryl Jaigobin2, Patrik Michel2, Mitchell S V Elkind2, Marco R Di Tullio2, Jennifer S Lutz2, John Griffith2, David M Kent2. 1. From the Department of Neurology (D.E.T., D.M.K.) and the Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies (R.R., J.S.L., J.G., D.M.K.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA; the University of Duisburg-Essen (C.W.), Germany; Hôpital Sainte-Anne (J.L.-M.), Paris-Descartes University, France; the Department of Neurology (J.S.), Hospital Universitari Doctor Josep Trueta Institut d'Investigació Biomèdica de Girona, Spain; the Department of Public Health and Primary Care (E.D.A.), Cambridge University, UK; the Department of Cardiology (F.P.), Sapienza University of Rome, Italy; the Departments of Cardiology (S.H.) and Neurology and Epidemiology (M.S.V.E.) and the Division of Cardiology (M.R.D.T.), Columbia University, New York; Inselspital (H.P.M., M.-L.M.), University of Bern; the Division of Neurology (K.N.), Triemli Municipal Hospital, Zurich, Switzerland; the University of Toronto (C.J.), Canada; and Centre Hospitalier Universitaire Vaudois (P.M.), Switzerland. dthaler@tuftsmedicalcenter.org. 2. From the Department of Neurology (D.E.T., D.M.K.) and the Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies (R.R., J.S.L., J.G., D.M.K.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA; the University of Duisburg-Essen (C.W.), Germany; Hôpital Sainte-Anne (J.L.-M.), Paris-Descartes University, France; the Department of Neurology (J.S.), Hospital Universitari Doctor Josep Trueta Institut d'Investigació Biomèdica de Girona, Spain; the Department of Public Health and Primary Care (E.D.A.), Cambridge University, UK; the Department of Cardiology (F.P.), Sapienza University of Rome, Italy; the Departments of Cardiology (S.H.) and Neurology and Epidemiology (M.S.V.E.) and the Division of Cardiology (M.R.D.T.), Columbia University, New York; Inselspital (H.P.M., M.-L.M.), University of Bern; the Division of Neurology (K.N.), Triemli Municipal Hospital, Zurich, Switzerland; the University of Toronto (C.J.), Canada; and Centre Hospitalier Universitaire Vaudois (P.M.), Switzerland.
Abstract
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.
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.
Authors: Magnus C Johansson; Peter Eriksson; Cecilia Wallentin Guron; Mikael Dellborg Journal: J Am Soc Echocardiogr Date: 2010-09-20 Impact factor: 5.251
Authors: David E Thaler; Robin Ruthazer; Emanuele Di Angelantonio; Marco R Di Tullio; Jennifer S Donovan; Mitchell S V Elkind; John Griffith; Shunichi Homma; Cheryl Jaigobin; Jean-Louis Mas; Heinrich P Mattle; Patrik Michel; Marie-Luise Mono; Krassen Nedeltchev; Federica Papetti; Joaquín Serena; Christian Weimar; David M Kent Journal: Stroke Date: 2013-01-22 Impact factor: 7.914
Authors: Bernhard Meier; Bindu Kalesan; Heinrich P Mattle; Ahmed A Khattab; David Hildick-Smith; Dariusz Dudek; Grethe Andersen; Reda Ibrahim; Gerhard Schuler; Antony S Walton; Andreas Wahl; Stephan Windecker; Peter Jüni Journal: N Engl J Med Date: 2013-03-21 Impact factor: 91.245
Authors: David E Thaler; Emanuele Di Angelantonio; Marco R Di Tullio; Jennifer S Donovan; John Griffith; Shunichi Homma; Cheryl Jaigobin; Jean-Louis Mas; Heinrich P Mattle; Patrik Michel; Marie-Luise Mono; Krassen Nedeltchev; Federica Papetti; Robin Ruthazer; Joaquín Serena; Christian Weimar; Mitchell S V Elkind; David M Kent Journal: Int J Stroke Date: 2012-08-09 Impact factor: 5.266
Authors: Benjamin S Wessler; David M Kent; David E Thaler; Robin Ruthazer; Jennifer S Lutz; Joaquín Serena Journal: Cerebrovasc Dis Date: 2015-07-11 Impact factor: 2.762