title: Association between anatomic features of atrial septal abnormalities obtained by omni-plane transesophageal echocardiography and stroke recurrence in cryptogenic stroke patients with patent foramen ovale.
abstract: The association between the anatomic characteristics obtained by omni-plane transesophageal echocardiography (TEE) and stroke recurrence in patients with cryptogenic stroke and patent foramen ovale (PFO) remains unclear. In the present longitudinal follow-up study, we sought to investigate whether PFO findings assessed by TEE can predict stroke recurrence. Of the 1,014 consecutive patients with acute ischemic stroke referred for TEE, 184 (mean +/- SD age, 51 +/- 14 years) were classified as having cryptogenic stroke with PFO, and follow-up data were available for 181 patients. During follow-up (median 3.5 years), 14 patients (7.7%) experienced stroke recurrence. Multivariate analysis showed that atrial septal aneurysm or hypermobility of the atrial septum (hazard ratio 6.04, 95% confidence interval 1.84 to 19.86, p = 0.003) and PFO size (hazard ratio 3.00, 95% confidence interval 1.96 to 4.60, p <0.0001) were independent predictors of stroke recurrence. The optimal cutoff value of PFO to predict stroke recurrence within 3 years was 3.0 mm (95% confidence interval 2.1 to 3.7 mm, area under the curve 0.889, p <0.001) with a sensitivity and specificity of 90.0% and 79.4%, respectively. Using this cutoff, the 3-year stroke recurrence-free survival rates differed significantly (98.9 +/- 1.1% vs 71.5 +/- 16.2%, p <0.001). In conclusion, our data suggest that risk stratification might be possible using the findings from TEE. The prophylactic benefit of PFO closure from these findings needs additional investigation.
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.forename: Sun Uck
authors.initials: SU
authors.lastname: Kwon
authors.forename: Jong Sung
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000368:Aged; D054087:Atrial Septum / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D018570:Risk Assessment; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control