Advertisement

Comparison of Frequencies of Patent Foramen Ovale and Thoracic Aortic Atherosclerosis in Patients With Cryptogenic Ischemic Stroke Undergoing Transesophageal Echocardiography

Published:September 05, 2011DOI:https://doi.org/10.1016/j.amjcard.2011.07.058
      Studies have shown an association between the presence of a patent foramen ovale (PFO) and cryptogenic stroke (CS) in patients aged <55 years. In addition, protruding atheromatous plaques in the ascending aorta and aortic arch are an independent risk factor for ischemic stroke in patients aged ≥55 years. The aim of this study was to determine the association of CS in the 2 age groups with PFO and with atheromatous plaques in the ascending aorta and in the aortic arch. Transesophageal echocardiograms in 229 patients evaluated for CS were compared to those in 314 patients evaluated for cardiac disease other than PFO with no histories of stroke (the control group). The prevalence of PFO and the presence of complex atheromatous plaques in the ascending aorta and aortic arch were determined in all patients and compared between the CS and control patients in the 2 age groups. The prevalence of PFO was significantly higher in patients with CS than in control patients among those aged <55 years (31 of 114 [27%] vs 24 of 171 [14%], p = 0.006) and those aged ≥55 years (28 of 115 [24%] vs 21 of 143 [15%], p = 0.049). The incidence of atrial septal aneurysm was similar in the 2 groups irrespective of patient age, as was the prevalence of complex atheromatous plaques. Multivariate analysis showed that PFO was independently associated with CS, irrespective of patient age (<55 years: odds ratio 2.4, 95% confidence interval 1.3 to 4.5, p = 0.01; ≥55 years: odds ratio 1.9, 95% confidence interval 1.1 to 3.5, p = 0.03). In conclusion, PFO was significantly associated with CS in younger (aged <55 years) and older (aged ≥55 years) patients. Atrial septal aneurysm and complex atheromas in the ascending aorta and aortic arch do not appear to be associated with CS.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sacco R.L.
        • Ellenberg J.H.
        • Mohr J.P.
        • Tatemichi T.K.
        • Hier D.B.
        • Price T.R.
        • Wolf P.A.
        Infarcts of undetermined cause: the NINCDS Stroke Data Bank.
        Ann Neurol. 1989; 25: 382-390
        • Mas J.-L.
        Patent foramen ovale, atrial septal aneurysm and ischaemic stroke in young adults.
        Eur Heart J. 1994; 15: 446-449
        • Overell J.R.
        • Bone I.
        • Lees K.R.
        Interatrial septal abnormalities and stroke: a meta-analysis of case control studies.
        Neurology. 2000; 55: 1172-1179
        • Chant H.
        • McCollum C.
        Stroke in young adults: the role of paradoxical embolism.
        Thromb Haemost. 2001; 85: 22-29
        • Handke M.
        • Harloff A.
        • Olschewski M.
        • Hetzel A.
        • Geibel A.
        Patent foramen ovale and cryptogenic stroke.
        N Engl J Med. 2007; 357: 2262-2268
        • Amarenco P.
        • Cohen A.
        • Tzourio C.
        • Bertrand B.
        • Hommel M.
        • Besson G.
        • Touboul P.-J.
        • Bousser M.-G.
        Atherosclerotic disease of the aortic arch and the risk of ischemic stroke.
        N Engl J Med. 1994; 331: 1474-1479
        • Stone D.A.
        • Hawke M.W.
        • LaMonte M.
        • Kittner Sj
        • Acosta J.
        • Corretti M.
        • Sample C.
        • Price T.R.
        • Plotnick G.D.
        Ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic stroke: a multiplane transesophageal echocardiographic study.
        Am Heart J. 1995; 130: 105-108
        • Ferrrari E.
        • Vidal R.
        • Chevallier T.
        • Baudouy M.
        Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: benefit of oral anticoagulants.
        J Am Coll Cardiol. 1999; 33: 1317-1322
        • Matsumura Y.
        • Osaki Y.
        • Fukui T.
        • Yabe T.
        • Yamasaki M.
        • Doi Y.
        Protruding atherosclerotic aortic plaques and dyslipidaemia: correlation to subtypes of ischemic stroke.
        Eur J Echocardiogr. 2002; 3: 8-12
        • Adams Jr, H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • Biller J.
        • Love B.B.
        • Gordon D.L.
        • Marsh E.E.
        • TOAST Investigators
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter trial.
        Stroke. 1993; 24: 35-41
        • Drighil A.
        • El Mosalami H.
        • Elbadaoui N.
        • Chraibi S.
        • Bennis A.
        Patent foramen ovale: a new disease?.
        Int J Cardiol. 2007; 122: 1-9
        • Force M.
        • Massabuau P.
        • Larrue V.
        Prevalence of atrial septal abnormalities in older patients with cryptogenic ischemic stroke or transient ischemic attack.
        Clin Neurol Neurosurg. 2008; 110: 779-783
        • Meissner I.
        • Khanderia B.K.
        • Sheps S.G.
        • Schwartz G.L.
        • Weibers D.O.
        • Whisnant J.P.
        • Covalt J.L.
        • Petterson T.M.
        • Christianson T.J.H.
        • Agmon Y.
        Atherosclerosis of the aorta: risk factor, risk marker or innocent bystander?.
        J Am Coll Cardiol. 2004; 44: 1018-1024
        • Gu X.
        • He Y.
        • Li Z.
        • Kontos M.C.
        • Paulsen W.H.J.
        • Arrowood J.A.
        • Vetrovec G.W.
        • Nixon J.V.
        Relation between the incidence, location and extent of thoracic aortic atherosclerosis detected by transesophageal echocardiography and the extent of coronary artery disease by angiography.
        Am J Cardiol. 2011; 107: 175-178
        • Petty G.W.
        • Brown Jr, R.D.
        • Whisnant J.P.
        • Sicks J.D.
        • O'Fallon W.M.
        • Wiebers D.O.
        Ischemic stroke subtypes: a population-based study of incidence and risk factors.
        Stroke. 1999; 30: 2513-2516
        • Cujec B.
        • Mainra R.
        • Johnson D.H.
        Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks.
        Can J Cardiol. 1999; 15: 57-64
        • Kolominsky-Rabas P.L.
        • Weber M.
        • Gefeller O.
        • Neundoerfer B.
        • Heuschmann P.U.
        Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence and long-term survival in ischemic stroke subtypes: a population-based study.
        Stroke. 2001; 32: 2735-2740
        • Cerrato P.
        • Imperiale D.
        • Priano L.
        • Maniardi L.
        • Morello M.
        • Marson A.M.
        • Carra F.
        • Barberis G.
        • Bergamasco B.
        Transesophageal echocardiography in patients without arterial and major cardiac sources of embolism: difference between stroke subtypes.
        Cerebrovasc Dis. 2002; 13: 174-183
        • De Castro S.
        • Rasura M.
        • Di Angelantonio E.
        • Beccia M.
        • Passaseo I.
        • Di Lisi F.
        • Fieschi C.
        • Pandian N.
        • Fedele F.
        Distribution of potential cardiac sources of embolism in young and older stroke patients: implications for recurrent vascular events.
        J Cardiovasc Med (Hagerstown). 2006; 7: 191-196
        • Di Tullio M.
        • Sacco R.L.
        • Gopal A.
        • Mohr J.P.
        • Homma S.
        Patent foramen ovale as a risk factor for cryptogenic stroke.
        Ann Intern Med. 1992; 177: 461-465
        • Ranoux D.
        • Cohen A.
        • Cabanes L.
        • Amarenco P.
        • Bousser M.G.
        • Mas J.L.
        Patent foramen ovale: is stroke due to paradoxical embolism.
        Stroke. 1993; 24: 31-34
        • Jones E.F.
        • Calafiore P.
        • Donnan G.A.
        • Tonkin A.M.
        Evidence that patent foramen ovale is not a risk factor for cerebral ischemia in the elderly.
        Am J Cardiol. 1994; 74: 596-599
        • Meissner I.
        • Khanderia B.K.
        • Heit J.A.
        • Petty G.W.
        • Sheps S.G.
        • Schwartz G.L.
        • Whisnant J.P.
        • Wiebers D.O.
        • Covalt J.L.
        • Petterson T.M.
        • Christianson T.J.
        • Agmon Y.
        Patent foramen ovale: innocent or guilty?.
        J Am Coll Cardiol. 2006; 47: 440-445
        • Whisnant J.P.
        • Wiebers D.O.
        • O'Fallon W.M.
        • Sicks J.D.
        • Frye R.L.
        A population based model of risk factors for ischemic stroke: Rochester, Minnesota.
        Neurology. 1996; 47: 1420-1428
        • Davila-Roman V.G.
        • Murphy S.F.
        • Nickerson N.J.
        • Kouchoukos N.T.
        • Schechtman K.B.
        • Barzilai B.
        Atherosclerosis of the ascending aorta is an independent predictor of long-term neurological events and mortality.
        J Am Coll Cardiol. 1999; 33: 1308-1316
        • Agmon Y.
        • Khanderia B.K.
        • Meissner I.
        • Schwartz G.L.
        • Petterson T.M.
        • O'Fallon W.M.
        • Whisnant J.P.
        • Wiebers D.O.
        • Seward J.B.
        Relation of coronary artery disease and cerebrovascular disease with atherosclerosis of the thoracic aorta in the general population.
        Am J Cardiol. 2002; 89: 262-267
        • Petty G.W.
        • Khanderia B.K.
        • Meissner I.
        • Whisnant J.P.
        • Rocca W.A.
        • Sicks J.D.
        • Christianson T.J.
        • O'Fallon W.M.
        • McClelland R.L.
        • Wiebers D.O.
        Population-based study of the relationship between atherosclerosis aortic debris and cerebrovascular ischemic events.
        Mayo Clin Proc. 2006; 81: 609-614
        • Adams Jr, H.P.
        Cardiac disease and stroke: will history repeat itself?.
        Mayo Clin Proc. 2006; 81: 597-601
        • Goel S.S.
        • Tuzcu E.M.
        • Mehdi H.S.
        • de Oliveira E.I.
        • Przemyslaw P.B.
        • Krasuski R.A.
        • Rodriguez L.L.
        • Kapadia S.R.
        Morphology of the patent foramen ovale in asymptomatic versus symptomatic (stroke or transient ischemic attack) patients.
        Am J Cardiol. 2009; 103: 124-129