Rita Marinheiro1, Leonor Parreira2, Pedro Amador2, Isabel Silvestre2, Carla Antunes2, Rui Caria2. 1. Cardiology Department, Centro Hospitalar de Setubal, Rua Camilo Castelo Branco 175, 2910-446, Setubal, Portugal. ritamarinheiro@gmail.com. 2. Cardiology Department, Centro Hospitalar de Setubal, Rua Camilo Castelo Branco 175, 2910-446, Setubal, Portugal.
Abstract
BACKGROUND: Therapeutic uncertainty is inherent in decisions in patients with patent foramen ovale (PFO) and cryptogenic stroke. We aimed to determine clinical implications of PFO identification in transesophageal echocardiography (TEE) after a cryptogenic ischemic stroke. METHODS: Consecutive TEE done between 2011 and 2015 in patients with previous cryptogenic stroke was evaluated. Clinical implications of PFO identification (closure and/or medical therapy) were retrieved from the medical records and discharge summaries. Adverse events related to therapy, stroke recurrence and death were analyzed during follow-up. RESULTS: Three-hundred one patients (mean age 59 ± 11 years; 61% male) underwent a TEE, of which 77 (26%) patients had a diagnosis of PFO. Patients with PFO were younger (56 ± 13 versus 60 ± 14, p = 0.03). Of those with PFO, 23 (30%) underwent percutaneous closure of PFO and these patients had more frequently complex or large PFO (p < 0.001 and p = 0.004, respectively). The remaining 54 (70%) were treated with medical therapy: 30 (39%) with antiplatelet therapy and 24 (31%) with oral anticoagulation. During follow-up (44 ± 17 months), only two patients had another stroke (both referred for PFO closure, while they were waiting for the procedure) and two patients, on whom PFO closure was not performed, died (not for cardiovascular causes). CONCLUSION: PFO's (size and complexity) and patients' characteristics influenced clinical decision when PFO was detected on TEE. The risk for recurrent stroke was not increased in patients who did not undergo PFO closure; although two patients waiting for PFO closure had recurrent stroke, demonstrating its importance.
BACKGROUND: Therapeutic uncertainty is inherent in decisions in patients with patent foramen ovale (PFO) and cryptogenic stroke. We aimed to determine clinical implications of PFO identification in transesophageal echocardiography (TEE) after a cryptogenic ischemic stroke. METHODS: Consecutive TEE done between 2011 and 2015 in patients with previous cryptogenic stroke was evaluated. Clinical implications of PFO identification (closure and/or medical therapy) were retrieved from the medical records and discharge summaries. Adverse events related to therapy, stroke recurrence and death were analyzed during follow-up. RESULTS: Three-hundred one patients (mean age 59 ± 11 years; 61% male) underwent a TEE, of which 77 (26%) patients had a diagnosis of PFO. Patients with PFO were younger (56 ± 13 versus 60 ± 14, p = 0.03). Of those with PFO, 23 (30%) underwent percutaneous closure of PFO and these patients had more frequently complex or large PFO (p < 0.001 and p = 0.004, respectively). The remaining 54 (70%) were treated with medical therapy: 30 (39%) with antiplatelet therapy and 24 (31%) with oral anticoagulation. During follow-up (44 ± 17 months), only two patients had another stroke (both referred for PFO closure, while they were waiting for the procedure) and two patients, on whom PFO closure was not performed, died (not for cardiovascular causes). CONCLUSION: PFO's (size and complexity) and patients' characteristics influenced clinical decision when PFO was detected on TEE. The risk for recurrent stroke was not increased in patients who did not undergo PFO closure; although two patients waiting for PFO closure had recurrent stroke, demonstrating its importance.
Authors: Michael Handke; Andreas Harloff; Manfred Olschewski; Andreas Hetzel; Annette Geibel Journal: N Engl J Med Date: 2007-11-29 Impact factor: 91.245
Authors: Emer R McGrath; Jeremy S Paikin; Bahareh Motlagh; Omid Salehian; Moira K Kapral; Martin J O'Donnell Journal: Am Heart J Date: 2014-07-30 Impact factor: 4.749
Authors: Mauro Pepi; Arturo Evangelista; Petros Nihoyannopoulos; Frank A Flachskampf; George Athanassopoulos; Paolo Colonna; Gilbert Habib; E Bernd Ringelstein; Rosa Sicari; Jose Luis Zamorano; Marta Sitges; Pio Caso Journal: Eur J Echocardiogr Date: 2010-07
Authors: Anthony J Furlan; Mark Reisman; Joseph Massaro; Laura Mauri; Harold Adams; Gregory W Albers; Robert Felberg; Howard Herrmann; Saibal Kar; Michael Landzberg; Albert Raizner; Lawrence Wechsler Journal: N Engl J Med Date: 2012-03-15 Impact factor: 91.245
Authors: Lars Søndergaard; Scott E Kasner; John F Rhodes; Grethe Andersen; Helle K Iversen; Jens E Nielsen-Kudsk; Magnus Settergren; Christina Sjöstrand; Risto O Roine; David Hildick-Smith; J David Spence; Lars Thomassen Journal: N Engl J Med Date: 2017-09-14 Impact factor: 91.245
Authors: David J Gladstone; Melanie Spring; Paul Dorian; Val Panzov; Kevin E Thorpe; Judith Hall; Haris Vaid; Martin O'Donnell; Andreas Laupacis; Robert Côté; Mukul Sharma; John A Blakely; Ashfaq Shuaib; Vladimir Hachinski; Shelagh B Coutts; Demetrios J Sahlas; Phil Teal; Samuel Yip; J David Spence; Brian Buck; Steve Verreault; Leanne K Casaubon; Andrew Penn; Daniel Selchen; Albert Jin; David Howse; Manu Mehdiratta; Karl Boyle; Richard Aviv; Moira K Kapral; Muhammad Mamdani Journal: N Engl J Med Date: 2014-06-26 Impact factor: 91.245
Authors: John D Carroll; Jeffrey L Saver; David E Thaler; Richard W Smalling; Scott Berry; Lee A MacDonald; David S Marks; David L Tirschwell Journal: N Engl J Med Date: 2013-03-21 Impact factor: 91.245
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