Prevalence of myocardial scar in patients with cryptogenic cerebral ischemic events and patent foramen ovale.
OBJECTIVE
This study sought to evaluate the prevalence of subclinical myocardial infarctions with cardiovascular magnetic resonance imaging (CMRI) in patients with patent foramen ovale (PFO) after cryptogenic cerebral ischemic events.


BACKGROUND
A thrombotic mass passing a PFO may embolize in cerebral but also in coronary arteries, resulting in both cerebral and myocardial ischemic events. CMRI with late gadolinium enhancement (LGE) analysis is the most sensitive imaging technique to detect small myocardial infarctions.


METHODS
PFO patients (n = 74) with a first cryptogenic cerebral ischemic event without a clinical history for myocardial infarction underwent CMRI and coronary angiography. Right and left ventricular volumes and ejection fractions were measured by CMRI. LGE imaging was performed after administration of gadolinium-diethylenetriaminepentaacetic acid. The presence of atrial septal aneurysm (ASA) was evaluated by transesophageal echocardiography.


RESULTS
LGE was detected in 8 of 74 (10.8%) patients. LGE pattern was transmural or subendocardial. Patients with LGE and those without did not differ in cardiovascular risk factors, type of ischemic event, presence of ASA, right and left ventricular volumes, and ejection fractions. LGE volume was small and comprised only 7.9 +/- 2.4% of left ventricular muscle mass. Coronary artery disease was ruled out in 7 of 8 patients with LGE. There was a trend towards a larger PFO size in patients with LGE compared with patients without LGE (13.2 +/- 4.1 mm vs. 16.0 +/- 2.8 mm, p = 0.06).


CONCLUSIONS
Subclinical myocardial infarctions determined in CMRI were observed in 10.8% of patients with PFO after a first cryptogenic cerebral ischemic event. Our results strengthen the pathophysiologic role of a PFO with paradoxical embolism in patients with cryptogenic cerebral ischemic events.
Wöhrle
Jochen
J
Clinic of Internal Medicine II, University of Ulm, Ulm, Germany. jochen.woehrle@uniklinik-ulm.de
Kochs
Matthias
M
Hombach
Vinzenz
V
Merkle
Nico
N
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology*; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000453:epidemiology*; D019786:Gadolinium DTPA; D005858:Germany / Q000453:epidemiology; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D015995:Prevalence
D003287:Contrast Media; D019786:Gadolinium DTPA