title: Patent foramen ovale is not associated with an increased risk of stroke recurrence.
abstract: OBJECTIVE
  Despite numerous studies suggesting a relationship between paradoxical embolism from a patent foramen ovale (PFO) and stroke, the role of PFO as a risk factor for cerebral ischaemia remains controversial. We therefore sought to determine the association between a RLS detected by contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and recurrent stroke in an unselected population sample.
  
  
  METHODS
  We analyzed the records of 763 patients with diagnosis of cerebral ischaemia at our institution. All patients had undergone TCD-based detection of RLS. Embolic signals have been measured both under resting conditions and after performing a Valsalva maneuver. For follow-up, all patients were contacted by mail, which included a standardized questionnaire. Endpoints of follow-up were defined as recurrence of cerebral ischaemia, occurrence of myocardial infarction or death from any cause.
  
  
  RESULTS
  Follow-up data were available in 639 patients (83.7%). At baseline, a RLS was detected in 140 (28%) men and in 114 (42%) women. Ten shunt-carriers (1.6%) and 32 patients (5.0%) without RLS had suffered a recurrent stroke. After adjustment for age, sex, and atrial fibrillation, the hazard ratio of RLS for stroke recurrence was 0.86 (95% CI 0.41-1.79). The condition of RLS at rest adjusted for age, sex, stroke subtype, and cardiovascular risk factors was not found to increase the risk of stroke substantially (HR 1.16 [95% CI 0.41-3.29])
  
  
  CONCLUSIONS
  Our data suggest that the risk of recurrent stroke in subjects with PFO is not significantly increased in comparison with subject without it.
authors.affiliation: Department of Neurology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany. regina.feurer@gmx.de
authors.forename: R
authors.initials: R
authors.lastname: Feurer
authors.forename: S
authors.initials: S
authors.lastname: Sadikovic
authors.forename: D
authors.initials: D
authors.lastname: Sepp
authors.forename: L
authors.initials: L
authors.lastname: Esposito
authors.forename: M
authors.initials: M
authors.lastname: Schleef
authors.forename: A
authors.initials: A
authors.lastname: Bockelbrink
authors.forename: J
authors.initials: J
authors.lastname: Schwarze
authors.forename: B
authors.initials: B
authors.lastname: Hemmer
authors.forename: D
authors.initials: D
authors.lastname: Sander
authors.forename: H
authors.initials: H
authors.lastname: Poppert
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000209:etiology; D009460:Neurologic Examination; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012008:Recurrence; D012148:Restless Legs Syndrome / Q000150:complications / Q000209:etiology; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods
chemical_list: D010975:Platelet Aggregation Inhibitors