Background Studies to date have shown an association betweenthe presence of patent foramen ovale and cryptogenic strokein patients younger than 55 years of age. This association hasnot been established in patients 55 years of age or older.
Methods We prospectively examined 503 consecutive patients whohad had a stroke, and we compared the 227 patients with cryptogenicstroke and the 276 control patients with stroke of known cause.We examined the prevalences of patent foramen ovale and of patentforamen ovale with concomitant atrial septal aneurysm in allpatients, using transesophageal echocardiography. We also compareddata for the 131 younger patients (<55 years of age) andthose for the 372 older patients (55 years of age).
Results The prevalence of patent foramen ovale was significantlygreater among patients with cryptogenic stroke than among thosewith stroke of known cause, for both younger patients (43.9%vs. 14.3%; odds ratio, 4.70; 95% confidence interval [CI], 1.89to 11.68; P<0.001) and older patients (28.3% vs. 11.9%; oddsratio, 2.92; 95% CI, 1.70 to 5.01; P<0.001). Even strongerwas the association between the presence of patent foramen ovalewith concomitant atrial septal aneurysm and cryptogenic stroke,as compared with stroke of known cause, among both younger patients(13.4% vs. 2.0%; odds ratio, 7.36; 95% CI, 1.01 to 326.60; P=0.049)and older patients (15.2% vs. 4.4%; odds ratio, 3.88; 95% CI,1.78 to 8.46; P<0.001). Multivariate analysis adjusted forage, plaque thickness, and presence or absence of coronary arterydisease and hypertension showed that the presence of patentforamen ovale was independently associated with cryptogenicstroke in both the younger group (odds ratio, 3.70; 95% CI,1.42 to 9.65; P=0.008) and the older group (odds ratio, 3.00;95% CI, 1.73 to 5.23; P<0.001).
Conclusions There is an association between the presence ofpatent foramen ovale and cryptogenic stroke in both older patientsand younger patients. These data suggest that paradoxical embolismis a cause of stroke in both age groups.
Source Information
From the Departments of Cardiology and Angiology (M.H., A.G.), Neurology and Neurophysiology (A. Harloff, A. Hetzel), and Medical Biometry and Statistics (M.O.), University Hospital Freiburg, Freiburg, Germany. Drs. Handke and Harloff contributed equally to this article.
Address reprint requests to Dr. Handke at the Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland, or at handkem{at}uhbs.ch.
Patent Foramen Ovale and Cryptogenic Stroke
Meyer M. A., Kunavarapu C., Switzer J. A., Nichols F. III, Silver B., Russman A., Kent D. M., Trikalinos T. A., Thaler D. E., Handke M., Harloff A., Geibel A.
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N Engl J Med 2008;
358:1518-1521, Apr 3, 2008.
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