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Roy S, Le H, Balogun A, Caskey E, Tessitore T, Kota R, Hejirika J, Yu S, Nguyen L, Lazo AL, Yard C, Monaghan M, Dhingra M, Modi S, Hunter K. Risk of Stroke in Patients With Patent Foramen Ovale Who Had Pulmonary Embolism. J Clin Med Res 2020; 12:190-199. [PMID: 32231756 PMCID: PMC7092756 DOI: 10.14740/jocmr4094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background The presence of patent foramen ovale (PFO) alone does not increase the risk of ischemic stroke. Several prospective studies with a small number of patients have shown that the risk of ischemic stroke is higher in patients with PFO and pulmonary embolism (PE). We studied the association of ischemic stroke in the patients who had PFO with PE (PFOwiPE) and compared with the patients who had PFO without PE (PFOwoPE). Methods Electronic medical records of 154 adult patients in our internal medicine office were reviewed. Thirty-four patients had PFOwiPE and 120 had PFOwoPE. Independent t-test and Mann-Whitney U-test were used to compare the continuous variables between the two groups, while Chi-square tests were applied to compare the categorical variables between the two groups. Logistic regression was used for multivariate analysis. The dependent variable was stroke and the independent variable of interest was PFO with, or without PE. Results Mean age of patients with PFOwiPE was 54.8 years and patients with PFOwoPE was 57.8 years (P = 0.331). Mean body mass index (BMI) of the patients with PFOwiPE was significantly greater than the patients with PFOwoPE (32.5 ± 8.84 kg/m2 vs. 28.4 ± 6.99 kg/m2; P < 0.05). Mean left ventricular ejection fraction (LVEF) and red blood cell (RBC) count of patients with PFOwiPE was significantly lower than patients with PFOwoPE (LVEF 54.9 ± 13.01% vs. 59.6 ± 6.85%, P < 0.05; RBC 4.1 ± 1.203 × 106/µL vs. 4.5 ± 0.596 × 106/µL, P < 0.05). There was significantly higher association of congestive heart failure (CHF) in patients with PFOwiPE compared to patients with PFOwoPE (20.6% vs. 7.5%; P < 0.05). Association of ischemic stroke was 35.3% in patients with PFOwiPE and 39.2% in patients with PFOwoPE. The difference was not statistically significant (P = 0.682). Conclusions Association of ischemic stroke was similar in patients with PFOwiPE and patients with PFOwoPE. Association of significantly higher BMI, lower LVEF, lower RBC count, and higher frequency of CHF were associated with patients with PFOwiPE compared to the patients with PFOwoPE.
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Affiliation(s)
- Satyajeet Roy
- Department of Medicine, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, USA
| | - Han Le
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Elizabeth Caskey
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Rasagnya Kota
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Siyuan Yu
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Long Nguyen
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | | | - Menaka Dhingra
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Sneha Modi
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, USA
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Reichenberger F, Kaps M, Seeger W, Tanislav C. Shunt volume dynamics in stroke patients with patent foramen ovale. J Appl Physiol (1985) 2013; 115:704-7. [PMID: 23743402 DOI: 10.1152/japplphysiol.00507.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A variation in right atrial and pulmonary arterial pressure might result in a shunt dynamic across a patent foramen ovale (PFO). In the present study we tested if peak exercise facilitates a restoration of right to left shunt (RLS) in stroke patients who demonstrated a functional PFO closure (no evidence of RLS across an initially demonstrated PFO). In stroke patients with PFO demonstrating a functional closure, the RLS was reassessed on peak exercise using contrast-enhanced transcranial Doppler sonography. The exercise procedure consisted of a cardiopulmonary exercise test with supplementary stress echocardiography for assessment of pulmonary circulation. Four stroke patients with initially PFO curtain pattern and a subsequent functional PFO closure (no evidence for RLS) underwent the procedure. In all four patients a RLS could be resurrected during peak physical exercise after a Valsalva strain. While in two patients peak exercise led to an RLS in a countable range of microembolic signals, in two patients a curtain pattern was obtained. One patient showed evidence for reoccurrence of RLS on peak exercise without a Valsalva strain. The patients with curtain pattern had a better peak exercise performance. Although the systolic pulmonary arterial pressure increased during exercise in all patients, there was no direct correlation with the detected RLS. After a functional PFO closure peak exercise combined with a Valsalva strain facilitates the reoccurrence of RLS in stroke patients.
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Affiliation(s)
- F Reichenberger
- University Giessen Lung Center, University Hospital Giessen, Giessen, Germany
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