Age is not a predictor of patent foramen ovale with right-to-left shunt in patients with cerebral ischemic events.
BACKGROUND
Patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) is highly associated with cerebral ischemic events in young patients. The prevalence of PFO and ASA in elderly patients with cerebral ischemic events is not well described.


OBJECTIVE
Our study is to evaluate the frequencies of PFO with right-to-left shunt (RLS) and ASA in elderly patients and to determine whether age is a predictor of flow-reversed PFO with RLS in cerebral ischemic events.


METHODS
A prospective registry for all consecutive patients with cerebral ischemic events who were evaluated by transesophageal echocardiography (TEE) for the detection of possible cardiac source of embolization was established and maintained in a university hospital. Patients' demographics including age, gender, ethnic origin, cerebrovascular risk factors, and all positive TEE data were collected from July 2000 to August 2001 for statistical analysis. A univariate and multivariate stepwise logistic regression analysis was performed.


RESULTS
In older patients the prevalence of PFO with RLS, PFO, and ASA was 25/118 (20%), 28/118 (24%), and 38/118 (32%), respectively, as opposed to younger patients, in whom it was 35/119 (30%), 39/119 (33%), and 38/119 (32%), respectively. Older patients had higher frequencies of hypertension (59; 69%), CAD (25; 21%), and prior history of stroke (23; 20%) as opposed to younger patients. Younger age (<60 years), gender, smoking history, hypertension, hyperlipidemia, CAD, and prior history of stroke were not associated with higher prevalence of PFO with RLS. Patent foramen ovale was associated with ASA (P < 0.001) and LVH (P < 0.019) in patients with TIA and stroke. In multivariate analysis only ASA (P < 0.001) remained significant with PFO, with RLS controlling for age, gender, and LVH.


CONCLUSIONS
PFO with RLS and ASA are frequently present in elderly stroke and/or TIA patients and age is not a predictor for PFO. Transesophageal echocardiography should be considered for all stroke and/or TIA patients irrespective of their age.
Department of Neurosurgery, Neurology and Cardiology, School of Medicine and Biomedical Sciences, State University of New York and Toshiba Stroke Research Center, Buffalo, New York, USA. yahia25@hotmail.com
Abutaher M
AM
Yahia
Aasma
A
Shaukat
Jawad F
JF
Kirmani
Adnan I
AI
Qureshi
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D003287:Contrast Media / Q000008:administration & dosage; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D013223:Statistics as Topic; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology
D003287:Contrast Media