Race-ethnic differences in patent foramen ovale, atrial septal aneurysm, and right atrial anatomy among ischemic stroke patients.
OBJECTIVE
Stroke remains a substantial cause of mortality and morbidity in the United States. Racial differences in stroke incidence and mortality persist with well-known excesses among blacks. Information on stroke among Hispanics is limited. In particular, little is known about whether patent foramen ovale (PFO), atrial septal aneurysm (ASA), and other atrial anomalies associated with cryptogenic stroke differ among minority populations.


METHODS
As a part of the PFO in Cryptogenic Stroke Study, transesophageal echocardiography was performed in a cohort of 630 ischemic stroke patients (mean age, 59+/-12 years; 44% women; 45% whites, 35% blacks, 17% Hispanics, 3% other). The prevalences of PFO, ASA, and right atrial (RA) anatomy favoring paradoxical embolization were compared among race-ethnic groups. Statistical analyses used analysis of variance for continuous variables and logistic regression for dichotomous variables with adjustments for age and sex.


RESULTS
Age- and sex-adjusted prevalences of PFO and ASA were similar across race-ethnic subgroups. However, large PFO was significantly less prevalent among blacks than among whites (odds ratio, 0.47; 95% confidence interval, 0.24 to 0.91; P=0.02). RA anatomy favoring paradoxical embolization was also significantly less prevalent among blacks compared with whites (odds ratio, 0.62; 95% confidence interval, 0.43 to 0.91; P=0.01). There were no significant differences in prevalence between whites and Hispanics.


CONCLUSIONS
Although the frequency of PFO did not vary among race-ethnic groups, a large PFO and RA anatomy favoring paradoxical embolization were significantly more prevalent among whites and Hispanics compared with blacks. These may be relatively more important risk factors for stroke among whites and Hispanics than among blacks.
Rodriguez
Carlos J
CJ
Columbia University, College of Physicians and Surgeons, Department of Medicine, Division of Cardiology, 630 W 168th St, New York, NY 10032, USA.
Homma
Shunichi
S
Sacco
Ralph L
RL
Di Tullio
Marco R
MR
Sciacca
Robert R
RR
Mohr
J P
JP
D017677:Age Distribution; D002545:Brain Ischemia / Q000453:epidemiology / Q000208:ethnology / Q000235:genetics*; D015331:Cohort Studies; D015897:Comorbidity; D017548:Echocardiography, Transesophageal; D005260:Female; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000235:genetics*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000208:ethnology / Q000235:genetics*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D016017:Odds Ratio; D015995:Prevalence; D044469:Racial Groups / Q000235:genetics*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology / Q000235:genetics*; D014481:United States / Q000453:epidemiology; D044465:White People