Thromb Haemost
DOI: 10.1055/s-0040-1715831
Stroke, Systemic or Venous Thromboembolism

Atrial Cardiopathy and Likely Pathogenic Patent Foramen Ovale in Embolic Stroke of Undetermined Source

Ioannis A. Leventis
1  Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
,
Dimitrios Sagris
1  Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
,
Davide Strambo
2  Stroke Center, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
,
Kalliopi Perlepe
1  Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
,
Gaia Sirimarco
2  Stroke Center, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
,
Stefania Nannoni
2  Stroke Center, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
,
Eleni Korompoki
3  Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece
4  Division of Brain Sciences, Department of Stroke Medicine, Imperial College London, London, United Kingdom
,
Efstathios Manios
3  Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece
,
Konstantinos Makaritsis
1  Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
,
Konstantinos Vemmos
3  Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece
,
Patrik Michel
2  Stroke Center, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
,
1  Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
› Author Affiliations
Funding This analysis was performed in the data set of the AF-ESUS (Prediction of AF in ESUS) study (ClinicalTrials.gov Identifier: NCT02766205), which is an investigator-initiated study supported by Pfizer through the BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA). The Swiss Cardiology Foundation supported data collection in the ASTRAL registry.

Abstract

Background Atrial cardiopathy and likely pathogenic patent foramen ovale (PFO) are two potential embolic sources in patients with embolic stroke of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear.

Methods Atrial cardiopathy was defined as increased left atrial diameter index (> 23 mm/m2) or left atrial volume index (> 34 mL/m2), or PR prolongation (≥ 200 ms), or presence of supraventricular extrasystoles in the electrocardiograms performed during hospitalization for the index stoke. The presence of PFO was assessed by transthoracic echocardiography with microbubble test or by transesophageal echocardiography. The presence of PFO was considered as likely pathogenic if the Risk of Paradoxical Embolism score was 7 to 10.

Results Among 367 ESUS patients with available information about the presence of PFO and the presence of atrial cardiopathy (median age: 61 years, 40.6% women), likely pathogenic PFO was diagnosed in 62 (16.9%) and atrial cardiopathy in 122 (33.2%). Only 4 patients (1.1%) had both likely pathogenic PFO and atrial cardiopathy. The prevalence of atrial cardiopathy was lower in patients with likely pathogenic PFO (6.5%) compared with patients with likely incidental PFO (31.2%) or without PFO (40.6%) (Pearson's chi-square test: 26.08, p < 0.001; adjusted odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.09–0.86). The prevalence of likely pathogenic PFO was lower in patients with atrial cardiopathy compared with patients without atrial cardiopathy (3.3% vs. 23.7%, respectively [Pearson's chi-square test: 24.13, p < 0.001; adjusted OR: 0.2, 95% CI: 0.02–0.6]).

Conclusion The presence of atrial cardiopathy is inversely related to the presence of likely pathogenic PFO in patients with ESUS.



Publication History

Received: 08 June 2020

Accepted: 17 July 2020

Publication Date:
02 September 2020 (online)

Georg Thieme Verlag KG
Stuttgart · New York