Antonello D'Andrea1, Marc R Dweck2, Espen Holte3,4, Ricardo Fontes-Carvalho5, Matteo Cameli6, Hatem Soliman Aboumarie7, Hans Christoph Diener8, Kristina H Haugaa9,10. 1. Department of Cardiology, Umberto I_ Hospital, Luigi Vanvitelli University - Nocera Inferiore (ASL Salerno), Viale San Francesco - 84014 Caserta, Italy. 2. BHF Centre for Cardiovascular Science, Department of Cardiology, University of Edinburgh, Edinburgh, EH16 4SB, UK. 3. Department of Cardiology, St. Olavs Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway. 4. Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, PO Box 8905, 7491 Trondheim, Norway. 5. Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. 6. Department of Cardiovascular Diseases, University of Siena, Policlinico Le Scotte, Viale Bracci 16, 53100 Siena, Italy. 7. Department of Cardiology - Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, UB9 6JH London, UK. 8. Department of Neurology - Medical Faculty of the University Duisburg-Essen-Institute for Medical Informatics, Biometry and Epidemiology, Hufelandstraße, 26, 45147 Essen, Germany. 9. Department of Cardiology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway. 10. Department of Cardiology - Institute for Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
Abstract
AIMS: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate the current practice for the assessment and management of patients with suspected patent foramen ovale (PFO) and cryptogenic stroke. METHODS AND RESULTS: In total, 79 imaging centres from 34 countries across the world responded to the survey, which comprised 17 questions. Most non-invasive investigations for PFO were widely available in the responding centres, with the exception of transcranial colour Doppler which was only available in 70% of sites, and most commonly performed by neurologists. Standard transthoracic echocardiography, with or without bubbles, was considered the first-level test for suspected PFO in the majority of the centres, whereas transoesophageal echocardiography was an excellent second-level modality. Most centres would rule out atrial fibrillation (AF) as a source of embolism in all patients with cryptogenic stroke (63%), with the remainder reserving investigation for patients with multiple AF risk factors (33%). Cardiac magnetic resonance was the preferred tool for identifying other unusual aetiologies, like cardiac masses or thrombi. After PFO closure, there was variation in the use of antiplatelet therapy: a quarter recommended treatment for life, while only 12% recommended 5 years as stipulated in the guidelines (12%). Antibiotic prophylaxis prior to dental or endoscopic procedures was not recommended in 41% of centres, contrary to what the guidelines recommended. CONCLUSION: Our survey revealed a variable adherence to the current recommendations for the diagnosis and management of patients with cryptogenic stroke and PFO. Efforts should focus on optimizing and standardizing diagnostic tests and treatment of this condition. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate the current practice for the assessment and management of patients with suspected patent foramen ovale (PFO) and cryptogenic stroke. METHODS AND RESULTS: In total, 79 imaging centres from 34 countries across the world responded to the survey, which comprised 17 questions. Most non-invasive investigations for PFO were widely available in the responding centres, with the exception of transcranial colour Doppler which was only available in 70% of sites, and most commonly performed by neurologists. Standard transthoracic echocardiography, with or without bubbles, was considered the first-level test for suspected PFO in the majority of the centres, whereas transoesophageal echocardiography was an excellent second-level modality. Most centres would rule out atrial fibrillation (AF) as a source of embolism in all patients with cryptogenic stroke (63%), with the remainder reserving investigation for patients with multiple AF risk factors (33%). Cardiac magnetic resonance was the preferred tool for identifying other unusual aetiologies, like cardiac masses or thrombi. After PFO closure, there was variation in the use of antiplatelet therapy: a quarter recommended treatment for life, while only 12% recommended 5 years as stipulated in the guidelines (12%). Antibiotic prophylaxis prior to dental or endoscopic procedures was not recommended in 41% of centres, contrary to what the guidelines recommended. CONCLUSION: Our survey revealed a variable adherence to the current recommendations for the diagnosis and management of patients with cryptogenic stroke and PFO. Efforts should focus on optimizing and standardizing diagnostic tests and treatment of this condition. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Aristeidis H Katsanos; Theodora Psaltopoulou; Theodoros N Sergentanis; Alexandra Frogoudaki; Agathi-Rosa Vrettou; Ignatios Ikonomidis; Ioannis Paraskevaidis; John Parissis; Chrysa Bogiatzi; Christina Zompola; John Ellul; Nikolaos Triantafyllou; Konstantinos Voumvourakis; Athanassios P Kyritsis; Sotirios Giannopoulos; Anne W Alexandrov; Andrei V Alexandrov; Georgios Tsivgoulis Journal: Ann Neurol Date: 2016-03-11 Impact factor: 10.422
Authors: Ana Clara Rodrigues; Michael H Picard; Aime Carbone; Ana Lúcia Arruda; Thaís Flores; Juliana Klohn; Meive Furtado; Edgar B Lira-Filho; Giovanni G Cerri; José L Andrade Journal: J Am Soc Echocardiogr Date: 2013-08-28 Impact factor: 5.251
Authors: Christian Pristipino; Horst Sievert; Fabrizio D'Ascenzo; Jean-Louis Mas; Bernhard Meier; Paolo Scacciatella; David Hildick-Smith; Fiorenzo Gaita; Danilo Toni; Paul Kyrle; John Thomson; Geneviève Derumeaux; Eustaquio Onorato; Dirk Sibbing; Peter Germonpré; Sergio Berti; Massimo Chessa; Francesco Bedogni; Dariusz Dudek; Marius Hornung; Jose Zamorano Journal: EuroIntervention Date: 2019-01-20 Impact factor: 6.534
Authors: D W Droste; J U Kriete; J Stypmann; M Castrucci; T Wichter; R Tietje; B Weltermann; P Young; E B Ringelstein Journal: Stroke Date: 1999-09 Impact factor: 7.914
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