Patent foramen ovale is not associated with an increased risk of stroke recurrence

• Published in: European journal of neurology Vol. 17; no. 11; pp. 1339 - 1345
• Main Authors: Feurer, R., Sadikovic, S., Sepp, D., Esposito, L., Schleef, M., Bockelbrink, A., Schwarze, J., Hemmer, B., Sander, D., Poppert, H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2010; John Wiley & Sons, Inc
• Subjects: Adult; Age Factors; Aged; cardiac embolism; Cohort Studies; Electrocardiography; Female; Foramen Ovale, Patent - complications; Health risk assessment; Heart attacks; Heart Rate - physiology; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - etiology; Neurologic Examination; Platelet Aggregation Inhibitors - therapeutic use; Proportional Hazards Models; Recurrence; Restless Legs Syndrome - complications; Restless Legs Syndrome - etiology; right-to-left-shunt; Risk Factors; Stroke; Stroke - complications; Stroke - diagnosis; Stroke - etiology; Stroke - mortality; stroke in young adults; transcranial doppler; Ultrasonography, Doppler, Transcranial - methods
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/j.1468-1331.2010.03015.x

Background and Purpose:  Despite numerous studies suggesting a relationship between paradoxical embolism from a patent foramen ovale (PFO) and stroke, the role of PFO as a risk factor for cerebral ischaemia remains controversial. We therefore sought to determine the association between a RLS detected by contrast‐enhanced transcranial Doppler ultrasonography (c‐TCD) and recurrent stroke in an unselected population sample. Methods:  We analyzed the records of 763 patients with diagnosis of cerebral ischaemia at our institution. All patients had undergone TCD‐based detection of RLS. Embolic signals have been measured both under resting conditions and after performing a Valsalva maneuver. For follow‐up, all patients were contacted by mail, which included a standardized questionnaire. Endpoints of follow‐up were defined as recurrence of cerebral ischaemia, occurrence of myocardial infarction or death from any cause. Results:  Follow‐up data were available in 639 patients (83.7%). At baseline, a RLS was detected in 140 (28%) men and in 114 (42%) women. Ten shunt‐carriers (1.6%) and 32 patients (5.0%) without RLS had suffered a recurrent stroke. After adjustment for age, sex, and atrial fibrillation, the hazard ratio of RLS for stroke recurrence was 0.86 (95% CI 0.41–1.79). The condition of RLS at rest adjusted for age, sex, stroke subtype, and cardiovascular risk factors was not found to increase the risk of stroke substantially (HR 1.16 [95% CI 0.41–3.29]) Conclusion:  Our data suggest that the risk of recurrent stroke in subjects with PFO is not significantly increased in comparison with subject without it.