Prevalence of patent foramen ovale determined by transesophageal echocardiography in patients with cryptogenic stroke aged 55 years or older. Same as younger patients?

INTRODUCTION AND OBJECTIVES: To investigate the relationship between patent foramen ovale and cryptogenic stroke in patients aged > or =55 years. METHODS: This prospective study determined the presence of patent foramen ovale and atrial septal aneurysm using transesophageal echocardiography in 262 consecutive patients with a diagnosis of probable cryptogenic stroke. Data from 44 patients aged > or =55 years with cryptogenic stroke (Group A) were compared with those from two other groups: 194 patients aged <55 years with cryptogenic stroke (Group B) and 24 control patients aged > or =55 years with stroke of known origin, namely grade III-V aortic atheromatosis (Group C). RESULTS: The frequency of patent foramen ovale in Group A was similar to that in Group B (38% vs. 36%; P=.85) but significantly higher than that in Group C (38% vs. 8%; P=.029). The frequency of patent foramen ovale with concomitant atrial septal aneurysm was significantly higher in the study group (Group A) than in the control Group C (18% vs. 0; P=.039) and non-significantly higher than in Group B (18% vs. 11%; P=.11). CONCLUSIONS: The frequency of patent foramen ovale alone or in association with atrial septal aneurysm in patients with cryptogenic stroke aged > or =55 years was similar to that in those aged <55 years, but higher than that in patients aged > or =55 years with stroke of atherosclerotic origin. These data suggest that paradoxical embolism could be a cause of stroke in both age groups.

Prevalencia de foramen oval permeable diagnosticado mediante ecocardiografía transesofágica en pacientes de edad igual o mayor que 55 años con ictus criptogénico. ¿Es diferente que en pacientes jóvenes? / Prevalence of patent foramen ovale determined by transesophageal echocardiography in patients with cryptogenic stroke aged 55 years or older. Same as younger patients?

Introducción y objetivos. El propósito de este estudio es analizar la relación entre foramen oval permeable e ictus criptogénico en pacientes de edad ≥ 55 años. Métodos. Se estudió de forma prospectiva la presencia de foramen oval permeable y aneurisma del septo interauricular en 262 pacientes consecutivos con diagnóstico de probable ictus criptogénico mediante ecocardiografía transesofágica. Comparamos los datos de 44 pacientes de edad ≥ 55 años con ictus criptogénico (grupo A de estudio) con otros 2 grupos: 194 menores de 55 años con ictus criptogénico (grupo B) y 24 de un grupo control de 55 años o más con ictus de origen conocido (ateromatosis aórtica de grado II-III) (grupo C). Resultados. La frecuencia de foramen oval permeable fue similar en el grupo A y B (el 38 frente al 36%; p = 0,85) y significativamente mayor que en el grupo C (el 38 frente al 8%; p = 0,029). La frecuencia de foramen oval permeable más aneurisma del septo interauricular concomitante fue más alta en el grupo de estudio (A) que en el grupo control (C) (el 18% frente a 0; p = 0,039) y más alta, pero sin significación, que en el grupo B (el 18 frente al 11%; p = 0,11). Conclusiones. La frecuencia de foramen oval permeable, tanto aislado como con aneurisma del septo interauricular, es similar en pacientes con ictus criptogénico de edad ≥ 55 años y en aquellos menores de 55 años, y más alta que en los pacientes con 55 años o más con ictus de origen arteriosclerótico. Estos datos indican que la embolia paradójica parece ser el mecanismo del ictus en ambos grupos de pacientes (AU)

Introduction and objectives. To investigate the relationship between patent foramen ovale and cryptogenic stroke in patients aged ≥55 years. Methods. This prospective study determined the presence of patent foramen ovale and atrial septal aneurysm using transesophageal echocardiography in 262 consecutive patients with a diagnosis of probable cryptogenic stroke. Data from 44 patients aged ≥55 years with cryptogenic stroke (Group A) were compared with those from two other groups: 194 patients aged <55 years with cryptogenic stroke (Group B) and 24 control patients aged ≥55 years with stroke of known origin, namely grade III–V aortic atheromatosis (Group C). Results. The frequency of patent foramen ovale in Group A was similar to that in Group B (38% vs. 36%; P=.85) but significantly higher than that in Group C (38% vs. 8%; P=.029). The frequency of patent foramen ovale with concomitant atrial septal aneurysm was significantly higher in the study group (Group A) than in the control Group C (18% vs. 0; P=.039) and non-significantly higher than in Group B (18% vs. 11%; P=.11). Conclusions. The frequency of patent foramen ovale alone or in association with atrial septal aneurysm in patients with cryptogenic stroke aged ≥55 years was similar to that in those aged <55 years, but higher than that in patients aged ≥55 years with stroke of atherosclerotic origin. These data suggest that paradoxical embolism could be a cause of stroke in both age groups (AU)

[Prevalence of patent foramen ovale in young patients with cerebral ischemic accident of unknown origin]. / Prevalencia de foramen oval permeable en pacientes jóvenes con accidente isquémico cerebral de causa desconocida.

INTRODUCTION AND OBJECTIVE: Patent foramen ovale has been associated with stroke in young patients with cryptogenic stroke. The purpose of this study is to examine the prevalence of patent foramen ovale in this group of patients, as well as their anatomical and functional characteristics by contrast echocardiography, trying to determine ictus risk markers in young patients with acute ischemic stroke. PATIENTS AND METHOD: Prospective study of 90 patients under the age of 50 who were hospitalised consecutively due to a clinical presentation suggestive of stroke. No cause was found in 55 out of 90 (group I) and the rest, in which an stroke was finally disregarded, were used as the control group (group II). A transthoracic and transesophageal echocardiography examination with 2 types of contrast agents was performed in all patients to determine the presence of a patent foramen ovale and its anatomical and functional characteristics. RESULTS: Patent foramen ovale was observed more frequently in group I than in group II (43 versus 21%; p < 0.05). Among patients with a patent foramen ovale those with an ischemic stroke showed greater mobility of the oval membrane, more frequent large shunts of contrast in a single frame in the left heart, and more frequent shunts at rest. Transesophageal echocardiography without contrast showed a high sensitivity (90%) and specificity (93%) for detecting anatomically permeable foramen ovale whereas contrast transthoracic echocardiography showed a low sensitivity (13%). There were no differences between the two contrasts used. CONCLUSIONS: Near half of young patients with ischemic stroke of an unknown origin have a patent foramen ovale. A bigger mobility of the membrane of the oval cavity and a large degree of shunt contrast as well as shunt at rest detected by contrast transesophageal echocardiography, seem to identify patent foramen ovale patients with ischemic stroke. In these patients, transthoracic echocardiography has low sensibility for detecting permeability of the foramen ovale.

Prevalencia de foramen oval permeable en pacientes jóvenes con accidente isquémico cerebral de causa desconocida / Prevalence of patent foramen ovale in young patients with cryptogenic stroke

Introducción y objetivos. El foramen oval permeable se ha asociado a infartos cerebrales en pacientes jóvenes con ictus criptogénico. El objetivo de este estudio es determinar la prevalencia en este grupo de pacientes de foramen oval permeable, así como las características anatómicas y funcionales del mismo, mediante ecocardiografía con contraste, tratando de determinar los marcadores de riesgo de ictus en pacientes jóvenes con un foramen oval permeable. Pacientes y método. Estudio prospectivo en 90 pacientes menores de 50 años que ingresaron de forma consecutiva por sospecha clínica de accidente cerebrovascular. En 55 pacientes no se encontró ninguna causa (grupo I) y los restantes, en los que se descartó finalmente un ictus, fueron utilizados como grupo control (grupo II). A todos se les realizó un estudio ecocardiográfico transtorácico y transesofágico con 2 tipos de contrastes, para determinar la presencia de foramen oval y las características anatómicas y funcionales del mismo, comparando ambos grupos. Resultados. En el grupo de estudio existió un mayor número de foramen oval permeable que en el grupo control (43 frente a 21 por ciento; p < 0,05). Comparando a los pacientes con foramen permeable de ambos grupos existieron diferencias significativas en la mayor movilidad de la membrana de la fosa oval, en el mayor número de pacientes con paso amplio de contraste, así como con paso del mismo en situación de respiración basal, en el grupo de pacientes que habían tenido ictus. La ecografía transesofágica sin contraste demostró una alta sensibilidad (90 por ciento) y especificidad (93 por ciento) para detectar "foramen permeable anatómico", mientras que la ecografía transtorácica con contraste demostró una baja sensibilidad para detectarlo (13 por ciento). No hubo diferencias entre los 2 contrastes utilizados. Conclusiones. En casi la mitad de los pacientes jóvenes con ictus de origen desconocido se encuentra un foramen oval permeable. Una mayor movilidad de la membrana de la fosa oval y un paso amplio de contraste y en situación de respiración en reposo han resultado marcadores predictores de isquemia cerebral en estos pacientes. La ecografía transtorácica tiene una baja sensibilidad para detectar permeabilidad del foramen, y no existieron diferencias entre los dos contrastes utilizados (AU)