title: Patent foramen ovale increases the risk of acute ischemic stroke in patients with acute pulmonary embolism leading to right ventricular dysfunction.
abstract: BACKGROUND
  Patent foramen ovale (PFO) is an established risk factor for ischemic stroke. Since acute right ventricular dysfunction (RVD) observed in patients with PE can lead to right-to-left inter-atrial shunt via PFO, we hypothesized that PFO is a risk factor for ischemic stroke in PE with significant right ventricular dysfunction.
  
  
  METHODS
  55 patients (31 F, 24M), median age 49 years (range 19-83 years) with confirmed PE underwent echocardiography for RVD and PFO assessment. High risk acute PE was diagnosed in 3 (5.5%) patients, while 16 (29%) hemodynamically stable with RVD patients formed a group with intermediate-risk PE. PFO was diagnosed in 19 patients (34.5%). Diffusion-weighted MRI of the brain for acute ischemic stroke (AIS) was performed in all patients 4.91 ± 4.1 days after admission.
  
  
  RESULTS
  AIS was detected by MRI in 4 patients (7.3%). Only one stroke was clinically overt and resulted in hemiplegia. All 4 AIS occurred in the PFO positive group (4 of 19 patients), and none in subjects without PFO (21.0% vs 0%, p=0.02). Moreover, all AIS occurred in patients with RVD and PFO, and none in patients with PFO without RVD (50% vs 0%, p=0.038).
  
  
  CONCLUSIONS
  Our data suggest that acute pulmonary embolism resulting in right ventricular dysfunction may lead to acute ischemic stroke in patients with patent foramen ovale. However, the clinical significance of such lesions remains to be determined.
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Sylwia
authors.initials: S
authors.lastname: Goliszek
authors.affiliation: Dept. of Radiology, Medical University of Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Wiśniewska
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kurnicka
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lichodziejewska
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Ciurzyński
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kostrubiec
authors.affiliation: Dept. of Radiology, Medical University of Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Gołębiowski
authors.affiliation: Infant Jesus Teaching Hospital, Medical University of Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Babiuch
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Marzanna
authors.initials: M
authors.lastname: Paczynska
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Koć
authors.affiliation: Dept. of Radiology, Medical University of Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Palczewski
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Wyzgał
authors.affiliation: Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland. Electronic address: piotr.pruszczyk@wum.edu.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications / Q000209:etiology* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications* / Q000473:pathology; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000209:etiology* / Q000473:pathology; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000473:pathology; D055815:Young Adult
keywords: ischemic stroke; patent foramen ovale; pulmonary embolism; right ventricular dysfunction