Patent foramen ovale and infarct volume in cryptogenic stroke

Jin-Man Jung, Jong Young Lee, Hye Jin Kim, Youngrok Do, Sun U. Kwon, Jong S. Kim, Jae Kwan Song, Dong Wha Kang

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: The causal relationship between patent foramen ovale (PFO) and stroke is controversial. We hypothesized that if PFO is a pathway of embolic source, there might be a correlation between PFO characteristics (ie, size or extent of shunt) and ischemic lesion burden (ie, infarct volume and number). Methods: From ischemic stroke patients admitted to Asan Medical Center between January 2000 and October 2007, we identified those who had (1) acute ischemic lesion on diffusion-weighted imaging within 5 days of symptom onset and (2) cryptogenic stroke and only PFO detected by transesophageal echocardiography. PFO characteristics on echocardiographic studies included size, shunt grade, shunt pattern, and the presence of atrial septal aneurysm (ASA). Results: Enrolled were 75 patients (male, 56%; mean age, 45.3 ± 13.9 years), including 10 patients (13.3%) with ASA. In univariable analysis, PFO size was positively correlated with log-transformed infarct volume (LIV) (regression coefficient =.469, P =.009). After adjusting for hypertension, stroke history, and migraine (all P <.2), PFO size remained independently associated with LIV (regression coefficient =.481, P =.007). Lesion number was negatively correlated with PFO size (Spearman coefficient rho = -.251, P =.03). The initial National Institutes of Health Stroke Scale scores tended to be positively correlated with PFO size (Spearman coefficient rho =.223, P =.054). Conclusions: In cryptogenic stroke, PFO size and ischemic lesion burden were positively correlated. These results support that PFO may play a role as a pathway of embolic source in cryptogenic stroke.

Original languageEnglish
Pages (from-to)1399-1404
Number of pages6
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number8
DOIs
Publication statusPublished - 2013 Jan 1

Fingerprint

Patent Foramen Ovale
Stroke
Aneurysm
Transesophageal Echocardiography
National Institutes of Health (U.S.)
Migraine Disorders

Keywords

  • cryptogenic stroke
  • diffusion-weighted image
  • echocardiography
  • infarct burden
  • Patent foramen ovale

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Patent foramen ovale and infarct volume in cryptogenic stroke. / Jung, Jin-Man; Lee, Jong Young; Kim, Hye Jin; Do, Youngrok; Kwon, Sun U.; Kim, Jong S.; Song, Jae Kwan; Kang, Dong Wha.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 8, 01.01.2013, p. 1399-1404.

Research output: Contribution to journalArticle

Jung, Jin-Man ; Lee, Jong Young ; Kim, Hye Jin ; Do, Youngrok ; Kwon, Sun U. ; Kim, Jong S. ; Song, Jae Kwan ; Kang, Dong Wha. / Patent foramen ovale and infarct volume in cryptogenic stroke. In: Journal of Stroke and Cerebrovascular Diseases. 2013 ; Vol. 22, No. 8. pp. 1399-1404.
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AU - Jung, Jin-Man

AU - Lee, Jong Young

AU - Kim, Hye Jin

AU - Do, Youngrok

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AU - Kim, Jong S.

AU - Song, Jae Kwan

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N2 - Background: The causal relationship between patent foramen ovale (PFO) and stroke is controversial. We hypothesized that if PFO is a pathway of embolic source, there might be a correlation between PFO characteristics (ie, size or extent of shunt) and ischemic lesion burden (ie, infarct volume and number). Methods: From ischemic stroke patients admitted to Asan Medical Center between January 2000 and October 2007, we identified those who had (1) acute ischemic lesion on diffusion-weighted imaging within 5 days of symptom onset and (2) cryptogenic stroke and only PFO detected by transesophageal echocardiography. PFO characteristics on echocardiographic studies included size, shunt grade, shunt pattern, and the presence of atrial septal aneurysm (ASA). Results: Enrolled were 75 patients (male, 56%; mean age, 45.3 ± 13.9 years), including 10 patients (13.3%) with ASA. In univariable analysis, PFO size was positively correlated with log-transformed infarct volume (LIV) (regression coefficient =.469, P =.009). After adjusting for hypertension, stroke history, and migraine (all P <.2), PFO size remained independently associated with LIV (regression coefficient =.481, P =.007). Lesion number was negatively correlated with PFO size (Spearman coefficient rho = -.251, P =.03). The initial National Institutes of Health Stroke Scale scores tended to be positively correlated with PFO size (Spearman coefficient rho =.223, P =.054). Conclusions: In cryptogenic stroke, PFO size and ischemic lesion burden were positively correlated. These results support that PFO may play a role as a pathway of embolic source in cryptogenic stroke.

AB - Background: The causal relationship between patent foramen ovale (PFO) and stroke is controversial. We hypothesized that if PFO is a pathway of embolic source, there might be a correlation between PFO characteristics (ie, size or extent of shunt) and ischemic lesion burden (ie, infarct volume and number). Methods: From ischemic stroke patients admitted to Asan Medical Center between January 2000 and October 2007, we identified those who had (1) acute ischemic lesion on diffusion-weighted imaging within 5 days of symptom onset and (2) cryptogenic stroke and only PFO detected by transesophageal echocardiography. PFO characteristics on echocardiographic studies included size, shunt grade, shunt pattern, and the presence of atrial septal aneurysm (ASA). Results: Enrolled were 75 patients (male, 56%; mean age, 45.3 ± 13.9 years), including 10 patients (13.3%) with ASA. In univariable analysis, PFO size was positively correlated with log-transformed infarct volume (LIV) (regression coefficient =.469, P =.009). After adjusting for hypertension, stroke history, and migraine (all P <.2), PFO size remained independently associated with LIV (regression coefficient =.481, P =.007). Lesion number was negatively correlated with PFO size (Spearman coefficient rho = -.251, P =.03). The initial National Institutes of Health Stroke Scale scores tended to be positively correlated with PFO size (Spearman coefficient rho =.223, P =.054). Conclusions: In cryptogenic stroke, PFO size and ischemic lesion burden were positively correlated. These results support that PFO may play a role as a pathway of embolic source in cryptogenic stroke.

KW - cryptogenic stroke

KW - diffusion-weighted image

KW - echocardiography

KW - infarct burden

KW - Patent foramen ovale

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