Patent foramen ovale and ischemic stroke in young people: statistical association or causal relation?
OBJECTIVE
To determine if there are evidences of a causal relation between patent foramen ovale (PFO) x cryptogenic ischemic stroke (IS) in the young population and to analyze this relation in terms of causal criteria.


METHODS
A total of 168 young patients with IS was retrospectively evaluated and divided into two groups: cryptogenic and with a defined cause. As a routine procedure, the patients underwent investigation of the PFO by means of transesophageal echocardiogram and/or transcranial Doppler sonography, both of them associated with the bubble test. Multivariate analysis was performed after demonstration of univariate statistical association between PFO x IS.


RESULTS
After multivariate analysis, the association between PFO x cryptogenic IS was still statistically significant with odds ratio (adjusted OR = 3.3; 95% CI: 1.5-7.4). The total number of cerebral lesions also presented a significant association with cryptogenic IS (adjusted OR = 0.4; 95% CI: 0.2-0.9). The association between PFO and cryptogenic IS met all the causality criteria.


CONCLUSIONS
The causal relation between PFO and cryptogenic IS in the young population is highly probable. This fact should be considered in the therapeutic decision.
Negrão
Edson Marcio
EM
Hospital SARAH, Brasília, DF, Brazil. emarcio@terra.com.br
Brandi
Ivar Viana
IV
Nunes
Simone Vilela
SV
Távora
Daniel Gurgel Fernandes
DG
Nakayama
Mauro
M
Beraldo
Paulo Sergio Siebra
PS
D000293:Adolescent; D000328:Adult; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*