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Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm.

Abstract

BACKGROUND AND PURPOSE

Patent foramen ovale (PFO) has been identified as a potential risk factor for stroke, but the mechanisms of PFO-associated stroke remain unsettled. The aim of our study was to evaluate possible differences in stroke risk factors and stroke patterns between patients with and without PFO that may give clues to the mechanism of PFO-associated stroke.

METHODS

This prospective, multicentric study involved 581 young cryptogenic stroke patients. The presence of PFO and atrial septal aneurysm was assessed by transesophageal echocardiography and reviewed independently by 2 experienced sonographers. Clinical, brain, and vascular imaging findings were reviewed by 2 neurologists and 2 neuroradiologists.

RESULTS

Of the 581 stroke patients, 267 (45.9%) had PFO. Patients with PFO were younger (OR, 0.95; 95% CI, 0.93 to 0.97) and less likely to have traditional risk factors such as hypertension (OR, 0.49; 95% CI, 0.28 to 0.85), hypercholesterolemia (OR, 0.56; 95% CI, 0.34 to 0.93), or current smoking (OR, 0.67; 95% CI, 0.47 to 0.97). Features suggestive of paradoxical embolism, such as Valsalva-provoking activities or deep vein thrombosis, were not more frequent in patients with PFO. Migraine was more common in patients with PFO (27.3%) than in those without PFO (14.0%). PFO (OR, 1.75; 95% CI, 1.08 to 2.82), particularly when associated with atrial septal aneurysm (OR, 2.71; 95% CI, 1.36 to 5.41), was significantly associated with migraine after adjustment for age and sex.

CONCLUSIONS

Differences in stroke risk factors and stroke patterns suggest that different stroke mechanisms occur in patients with and without PFO. PFO is significantly and independently associated with migraine, and this association is even stronger in patients with PFO and atrial septal aneurysm.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Neurology Department, Sainte-Anne Hospital, Paris, France.

    , , , , , ,

    Source

    Stroke 33:3 2002 Mar pg 706-11

    MeSH

    Adult
    Age Factors
    Echocardiography, Transesophageal
    Embolism, Paradoxical
    Female
    Heart Septal Defects, Atrial
    Humans
    Logistic Models
    Male
    Middle Aged
    Migraine Disorders
    Prospective Studies
    Risk Assessment
    Risk Factors
    Stroke

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    11872892

    Citation

    Lamy, C, et al. "Clinical and Imaging Findings in Cryptogenic Stroke Patients With and Without Patent Foramen Ovale: the PFO-ASA Study. Atrial Septal Aneurysm." Stroke, vol. 33, no. 3, 2002, pp. 706-11.
    Lamy C, Giannesini C, Zuber M, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke. 2002;33(3):706-11.
    Lamy, C., Giannesini, C., Zuber, M., Arquizan, C., Meder, J. F., Trystram, D., ... Mas, J. L. (2002). Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke, 33(3), pp. 706-11.
    Lamy C, et al. Clinical and Imaging Findings in Cryptogenic Stroke Patients With and Without Patent Foramen Ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke. 2002;33(3):706-11. PubMed PMID: 11872892.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. AU - Lamy,C, AU - Giannesini,C, AU - Zuber,M, AU - Arquizan,C, AU - Meder,J F, AU - Trystram,D, AU - Coste,J, AU - Mas,J L, PY - 2002/3/2/pubmed PY - 2002/3/19/medline PY - 2002/3/2/entrez SP - 706 EP - 11 JF - Stroke JO - Stroke VL - 33 IS - 3 N2 - BACKGROUND AND PURPOSE: Patent foramen ovale (PFO) has been identified as a potential risk factor for stroke, but the mechanisms of PFO-associated stroke remain unsettled. The aim of our study was to evaluate possible differences in stroke risk factors and stroke patterns between patients with and without PFO that may give clues to the mechanism of PFO-associated stroke. METHODS: This prospective, multicentric study involved 581 young cryptogenic stroke patients. The presence of PFO and atrial septal aneurysm was assessed by transesophageal echocardiography and reviewed independently by 2 experienced sonographers. Clinical, brain, and vascular imaging findings were reviewed by 2 neurologists and 2 neuroradiologists. RESULTS: Of the 581 stroke patients, 267 (45.9%) had PFO. Patients with PFO were younger (OR, 0.95; 95% CI, 0.93 to 0.97) and less likely to have traditional risk factors such as hypertension (OR, 0.49; 95% CI, 0.28 to 0.85), hypercholesterolemia (OR, 0.56; 95% CI, 0.34 to 0.93), or current smoking (OR, 0.67; 95% CI, 0.47 to 0.97). Features suggestive of paradoxical embolism, such as Valsalva-provoking activities or deep vein thrombosis, were not more frequent in patients with PFO. Migraine was more common in patients with PFO (27.3%) than in those without PFO (14.0%). PFO (OR, 1.75; 95% CI, 1.08 to 2.82), particularly when associated with atrial septal aneurysm (OR, 2.71; 95% CI, 1.36 to 5.41), was significantly associated with migraine after adjustment for age and sex. CONCLUSIONS: Differences in stroke risk factors and stroke patterns suggest that different stroke mechanisms occur in patients with and without PFO. PFO is significantly and independently associated with migraine, and this association is even stronger in patients with PFO and atrial septal aneurysm. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/11872892/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=11872892 DB - PRIME DP - Unbound Medicine ER -