title: Endocardial Device Leads in Patients with Patent Foramen Ovale: Echocardiographic Correlates of Stroke/TIA and Mortality.
abstract: BACKGROUND
  Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO.
  
  
  METHODS
  In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram.
  
  
  RESULTS
  Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447-2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95% CI 1.593-2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95% CI 1.351-1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up.
  
  
  CONCLUSIONS
  In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota.
authors.forename: Shiva P
authors.initials: SP
authors.lastname: Ponamgi
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Vaibhav R
authors.initials: VR
authors.lastname: Vaidya
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Desimone
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Amit
authors.initials: A
authors.lastname: Noheria
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida.
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Slusser
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Naser M
authors.initials: NM
authors.lastname: Ammash
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bruce
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.|Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
mesh_terms: D000368:Aged; D015984:Causality; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D054092:Foramen Ovale, Patent / Q000401:mortality*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality*; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D020521:Stroke / Q000401:mortality*; D015996:Survival Rate
keywords: defibrillator; echocardiography; leads; pacemaker; patent foramen ovale; stroke; transient ischemic attack