title: D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale.
abstract: Patent foramen ovale (PFO) is a potential cause of cryptogenic stroke, given the possibility of paradoxical embolism from venous to systemic circulation. D-dimer level is used to screen venous thrombosis. We investigated the risk of embolism and mortality according to the presence of PFO and D-dimer levels in cryptogenic stroke patients. A total of 570 first-ever cryptogenic stroke patients who underwent transesophageal echocardiography were included in this study. D-dimer was assessed using latex agglutination assay during admission. The association of long-term outcomes with the presence of PFO and D-dimer levels was investigated. PFO was detected in 241 patients (42.3 %). During a mean 34.0 ± 22.8 months of follow-up, all-cause death occurred in 58 (10.2 %) patients, ischaemic stroke in 33 (5.8 %), and pulmonary thromboembolism in 6 (1.1 %). Multivariate Cox regression analysis showed that a D-dimer level of > 1,000 ng/ml was an independent predictor for recurrent ischaemic stroke in patients with PFO (hazard ratio 5.341, 95 % confidence interval 1.648-17.309, p=0.005), but not in those without PFO. However, in patients without PFO, a D-dimer level of > 1,000 ng/ml was independently related with all-cause mortality. The risk of pulmonary thromboembolism tended to be high in patients with high D-dimer levels, regardless of PFO. Elevated D-dimer levels in cryptogenic stroke were predictive of the long-term outcome, which differed according to the presence of PFO. The coexistence of PFO and a high D-dimer level increased the risk of recurrent ischaemic stroke. The D-dimer test in cryptogenic stroke patients may be useful for predicting outcomes and deciding treatment strategy.
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Kim
authors.forename: Dongbeom
authors.initials: D
authors.lastname: Song
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.forename: Kijeong
authors.initials: K
authors.lastname: Lee
authors.forename: Joonsang
authors.initials: J
authors.lastname: Yoo
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.affiliation: Ji Hoe Heo, MD, PhD, Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752, Korea, Tel.: +82 2 2228 1605, Fax: +82 2 393 0705, E-mail: jhheo@yuhs.ac.
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D054092:Foramen Ovale, Patent / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007841:Latex Fixation Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D013997:Time Factors
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Cerebrovascular diseases; patent foramen ovale; stroke/prevention; thrombosis