Transesophageal Echocardiography in Cryptogenic Stroke and Patent Foramen Ovale : Analysis of Putative High-Risk Features From the Risk of Paradoxical Embolism Database
| Autor: | Robin Ruthazer, Emanuele Di Angelantonio, Joaquín Serena, Jennifer S. Lutz, David E. Thaler, Mitchell S.V. Elkind, Shunichi Homma, Federica Papetti, Christian Weimar, Heinrich Mattle, Jean-Louis Mas, Krassen Nedeltchev, David M. Kent, Bernhard Meier, Mark Reisman, Marco R. Di Tullio, Benjamin S. Wessler |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
business.industry Medizin 610 Medicine & health Odds ratio medicine.disease Heart septum Paradoxical embolism Embolism Internal medicine Predictive value of tests medicine Patent foramen ovale Cardiology Radiology Nuclear Medicine and imaging Cardiology and Cardiovascular Medicine business Chi-squared distribution Shunt (electrical) |
| Zdroj: | Wessler, Benjamin S.; Thaler, David E.; Ruthazer, Robin; Weimar, Christian; Di Tullio, Marco R.; Elkind, Mitchell S. V.; Homma, Shunichi; Lutz, Jennifer S.; Mas, Jean-Louis; Mattle, Heinrich P.; Meier, Bernhard; Nedeltchev, Krassen; Papetti, Federica; Di Angelantonio, Emanuele; Reisman, Mark; Serena, Joaquín; Kent, David M. (2014). Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale: analysis of putative high-risk features from the risk of paradoxical embolism database. Circulation. Cardiovascular Imaging, 7(1), pp. 125-131. Lippincott Williams & Wilkins 10.1161/CIRCIMAGING.113.000807 |
| DOI: | 10.1161/CIRCIMAGING.113.000807 |
| Popis: | Background— Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS), although the pathogenicity of a discovered PFO in the setting of CS is typically unclear. Transesophageal echocardiography features such as PFO size, associated hypermobile septum, and presence of a right-to-left shunt at rest have all been proposed as markers of risk. The association of these transesophageal echocardiography features with other markers of pathogenicity has not been examined. Methods and Results— We used a recently derived score based on clinical and neuroimaging features to stratify patients with PFO and CS by the probability that their stroke is PFO-attributable. We examined whether high-risk transesophageal echocardiography features are seen more frequently in patients more likely to have had a PFO-attributable stroke (n=637) compared with those less likely to have a PFO-attributable stroke (n=657). Large physiologic shunt size was not more frequently seen among those with probable PFO-attributable strokes (odds ratio [OR], 0.92; P =0.53). The presence of neither a hypermobile septum nor a right-to-left shunt at rest was detected more often in those with a probable PFO-attributable stroke (OR, 0.80; P =0.45; OR, 1.15; P =0.11, respectively). Conclusions— We found no evidence that the proposed transesophageal echocardiography risk markers of large PFO size, hypermobile septum, and presence of right-to-left shunt at rest are associated with clinical features suggesting that a CS is PFO-attributable. Additional tools to describe PFOs may be useful in helping to determine whether an observed PFO is incidental or pathogenically related to CS. |
| Databáze: | OpenAIRE |
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