David Vindiš1, Martin Hutyra2, Daniel Šaňák3, Michal Král3, Eva Čecháková4, Simona Littnerová5, Tomáš Adam6, Jan Přeček1, Štěpán Hudec1, Markéta Ječmenová1, Miloš Táborský1. 1. Department of Internal Medicine I-Cardiology, University Hospital and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic. 2. Department of Internal Medicine I-Cardiology, University Hospital and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic. Electronic address: martinhutyra@seznam.cz. 3. Comprehensive Stroke Center, Department of Neurology, University Hospital and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic. 4. Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic. 5. Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science, Masaryk University, Brno, Czech Republic. 6. Department of Clinical Biochemistry, University Hospital and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic.
Abstract
BACKGROUND: Pulmonary embolism (PE) is associated with a risk of consecutive paradoxical embolism with brain infarction through a patent foramen ovale (PFO). The aims of this study were to assess the rate of new ischemic brain lesions (IBLs) using magnetic resonance imaging (MRI) during a 12-month follow-up period with anticoagulation and to evaluate the potential relationship with the presence of PFO on transesophageal echocardiography (TEE). SUBJECTS AND METHODS: Seventy-eight patients with acute PE underwent baseline contrast TEE with brain MRI. After the 12-month follow-up, 58 underwent brain MRI. The rates of MRI documenting new IBLs were measured based on the presence of PFO. RESULTS: PFO was detected in 31 patients (39.7%). At baseline MRI, IBL was present in 39 of 78 patients (50%). The presence of IBL was not significantly higher in patients with PFO than in patients without PFO (20 [64.5% patients with PFO] versus 19 [40.4% without PFO] of 39 patients with baseline IBL, P = .063). At the follow-up MRI, in the group with new IBL (9 of 58 patients, 15.5%), the number of patients with PFO was significantly higher than that without PFO (7 [33.3%] versus 2 [5.4%], P = .008). PFO was identified as an independent predictor of new IBL (odds ratio 4.6 [1.6-47.4], P = .008). CONCLUSIONS: The presence of PFO was associated with new IBL in patients with PE. These patients are at a higher risk of ischemic stroke despite effective anticoagulation therapy.
BACKGROUND:Pulmonary embolism (PE) is associated with a risk of consecutive paradoxical embolism with brain infarction through a patent foramen ovale (PFO). The aims of this study were to assess the rate of new ischemic brain lesions (IBLs) using magnetic resonance imaging (MRI) during a 12-month follow-up period with anticoagulation and to evaluate the potential relationship with the presence of PFO on transesophageal echocardiography (TEE). SUBJECTS AND METHODS: Seventy-eight patients with acute PE underwent baseline contrast TEE with brain MRI. After the 12-month follow-up, 58 underwent brain MRI. The rates of MRI documenting new IBLs were measured based on the presence of PFO. RESULTS: PFO was detected in 31 patients (39.7%). At baseline MRI, IBL was present in 39 of 78 patients (50%). The presence of IBL was not significantly higher in patients with PFO than in patients without PFO (20 [64.5% patients with PFO] versus 19 [40.4% without PFO] of 39 patients with baseline IBL, P = .063). At the follow-up MRI, in the group with new IBL (9 of 58 patients, 15.5%), the number of patients with PFO was significantly higher than that without PFO (7 [33.3%] versus 2 [5.4%], P = .008). PFO was identified as an independent predictor of new IBL (odds ratio 4.6 [1.6-47.4], P = .008). CONCLUSIONS: The presence of PFO was associated with new IBL in patients with PE. These patients are at a higher risk of ischemic stroke despite effective anticoagulation therapy.
Authors: Jean Timnou Bekouti; Mialy Ravakiniaina Ranaivosoa; Akuvi Claude Adossou; Alpha Diawara; Ansoumane Camara; Manitrahasina Rambolarimanana; Pierre Lawani; Alain Ranjatson; Richard Houeze; Jean Louis Roynard Journal: Oxf Med Case Reports Date: 2020-07-24
Authors: Parth V Desai; Nicolas Krepostman; Matthew Collins; Sovik De Sirkar; Alexa Hinkleman; Kevin Walsh; Jawed Fareed; Amir Darki Journal: Curr Neurol Neurosci Rep Date: 2021-10-20 Impact factor: 5.081
Authors: Satyajeet Roy; Han Le; Ayobamidele Balogun; Elizabeth Caskey; Thomas Tessitore; Rasagnya Kota; Janice Hejirika; Siyuan Yu; Long Nguyen; Andrew Louis Lazo; Christopher Yard; Michael Monaghan; Menaka Dhingra; Sneha Modi; Krystal Hunter Journal: J Clin Med Res Date: 2020-03-02