Comparison of atrial septal defect and patent foramen ovale in cryptogenic strokes
Copyright © 2024. Published by Elsevier Inc..
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
|---|---|
| Enthalten in: |
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association - 33(2024), 6 vom: 28. Feb., Seite 107664 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Delabays, Constant [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Atrial septal defect |
|---|
| Anmerkungen: |
Date Revised 27.03.2024 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.1016/j.jstrokecerebrovasdis.2024.107664 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM369184300 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM369184300 | ||
| 003 | DE-627 | ||
| 005 | 20240329000637.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240302s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jstrokecerebrovasdis.2024.107664 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1353.xml |
| 035 | |a (DE-627)NLM369184300 | ||
| 035 | |a (NLM)38428550 | ||
| 035 | |a (PII)S1052-3057(24)00109-5 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Delabays, Constant |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparison of atrial septal defect and patent foramen ovale in cryptogenic strokes |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 27.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024. Published by Elsevier Inc. | ||
| 520 | |a OBJECTIVES: 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 | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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 | ||
| 520 | |a CONCLUSION: 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Atrial septal defect | |
| 650 | 4 | |a Cryptogenic stroke | |
| 650 | 4 | |a Paradoxical embolism | |
| 650 | 4 | |a Patent foramen ovale | |
| 700 | 1 | |a Correia, Pamela |e verfasserin |4 aut | |
| 700 | 1 | |a Eeckhout, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Delabays, Alain |e verfasserin |4 aut | |
| 700 | 1 | |a Michel, Patrik |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association |d 1991 |g 33(2024), 6 vom: 28. Feb., Seite 107664 |w (DE-627)NLM090676726 |x 1532-8511 |7 nnns |
| 773 | 1 | 8 | |g volume:33 |g year:2024 |g number:6 |g day:28 |g month:02 |g pages:107664 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2024.107664 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 33 |j 2024 |e 6 |b 28 |c 02 |h 107664 | ||