title: Evidence that patent foramen ovale is not a risk factor for cerebral ischemia in the elderly.
abstract: Patent foramen ovale (PFO) may be a risk factor for ischemic stroke in young patients. The aim of this study was to assess the importance of PFO in subjects with a wider age range using patient-control methodology. Transesophageal contrast echocardiography and carotid imaging were performed in 220 consecutive patients with cerebral ischemia (mean age 66 +/- 13 years) and in 202 community-based control subjects (mean age 64 +/- 11 years). Of patients with stroke, 35 (16%) had PFO compared with 31 control subjects (15%) (p = 0.98). Analysis of PFO prevalence by age did not show a significant difference between patients and controls subjects in the age groups < 50 years (27% vs 11%; p = 0.33), 50 to 69 years (17% vs 15%; p = 0.78), and > or = 70 years (12% vs 17%; p = 0.43). However, the group aged < 50 years was relatively small (26 cases, 19 controls). No significant difference in PFO prevalence was detected between patients with cryptogenic stroke (20%), noncryptogenic stroke (14%), and control subjects (15%). These results suggest that PFO is not a risk factor for cerebral ischemia in subjects aged > 50 years, which would have major implications for the investigation and management of stroke patients in this age group. Longitudinal studies are now required to assess the incidence of stroke in symptom-free patients with PFO.
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, Australia.
authors.forename: E F
authors.initials: EF
authors.lastname: Jones
authors.forename: P
authors.initials: P
authors.lastname: Calafiore
authors.forename: G A
authors.initials: GA
authors.lastname: Donnan
authors.forename: A M
authors.initials: AM
authors.lastname: Tonkin
mesh_terms: D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology*; D016009:Chi-Square Distribution; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D015588:Observer Variation; D012307:Risk Factors; D014463:Ultrasonography