Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

Modified Risk of Paradoxical Embolism More Effectively Evaluates the Risk of Stroke Associated with Patent Foramen Ovale

Author(s): Yun Wang*, Tun Zhao, Yajun Ma and Wenli Hu

Volume 20, Issue 3, 2023

Published on: 28 August, 2023

Page: [423 - 428] Pages: 6

DOI: 10.2174/1567202620666230825103401

Price: $65

Abstract

Background: Through an analysis of the risk factors associated with patent foramen ovale (PFO)-related stroke (PS), we aimed to modify the Risk of Paradoxical Embolism (RoPE) to assess the risk of PS.

Methods: A retrospective collection of ischemic stroke (IS) patients with PFO admitted to the Department of Neurology at Beijing Chaoyang Hospital was conducted. The patients were classified into PS and non-PS groups. PS risk factors and RoPE scoring were analyzed based on clinical data, laboratory indicators, and imaging data. Independent risk factors were incorporated into the RoPE scoring system for enhancement.

Results: Significant differences were observed between the two groups regarding total cholesterol, low-density lipoprotein-cholesterol (LDL-C), and uric acid levels. The transverse diameter of the left atrium was significantly larger in the non-PS group compared to the PS group. Multivariate logistic regression revealed that higher LDL-C levels and a smaller transverse diameter of the left atrium increased the risk of PS. The modified RoPE score was derived by assigning 1 point each for high LDL-C levels and the absence of transverse diameter enlargement in the left atrium. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves for the classical and modified RoPE score distinguishing PS were 0.661 and 0.798, respectively.

Conclusion: LDL-C levels and transverse diameter of the left atrium were identified as independent risk factors for PS. The modified RoPE scoring system exhibited superior performance in assessing the risk of PS compared to the original RoPE score.

« Previous
[1]
Perera KS, de Sa Boasquevisque D, Rao-Melacini P, et al. Evaluating rates of recurrent ischemic stroke among young adults with embolic stroke of undetermined source. JAMA Neurol 2022; 79(5): 450-8.
[http://dx.doi.org/10.1001/jamaneurol.2022.0048] [PMID: 35285869]
[2]
Lucà F, Pino PG, Parrini I, et al. Patent foramen ovale and cryptogenic stroke: Integrated management. J Clin Med 2023; 12(5): 1952.
[http://dx.doi.org/10.3390/jcm12051952] [PMID: 36902748]
[3]
Mazzucco S, Li L, Binney L, Rothwell PM. Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: A population-based study, systematic review, and meta-analysis. Lancet Neurol 2018; 17(7): 609-17.
[http://dx.doi.org/10.1016/S1474-4422(18)30167-4] [PMID: 29887162]
[4]
Diener HC, Wachter R, Wong A, et al. Monitoring for atrial fibrillation prior to patent foramen ovale closure after cryptogenic stroke. Int J Stroke 2023; 18(4): 400-7.
[http://dx.doi.org/10.1177/17474930221124412] [PMID: 36050817]
[5]
Sakharuk I, Drevets P, Coffey P, Nijim W, Patel V. Paradoxical emboli as a cause of stroke. Am Surg 2023; 89(7): 3286-8.
[http://dx.doi.org/10.1177/00031348231161704] [PMID: 36854125]
[6]
Koutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayiotides T. Epidemiology of patent foramen ovale in general population and in stroke patients: A narrative review. Front Neurol 2020; 11: 281.
[http://dx.doi.org/10.3389/fneur.2020.00281] [PMID: 32411074]
[7]
Kent DM, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology 2013; 81(7): 619-25.
[http://dx.doi.org/10.1212/WNL.0b013e3182a08d59] [PMID: 23864310]
[8]
Giannandrea D, Padiglioni C, Eusebi P, et al. Clinical RoPE (cRoPE) score predicts patent foramen ovale detection among stroke patients: A multicenter observational study. Neurol Sci 2020; 41(11): 3227-33.
[http://dx.doi.org/10.1007/s10072-020-04386-6] [PMID: 32388644]
[9]
Katsanos AH, Psaltopoulou T, Sergentanis TN, et al. Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia: A systematic review and diagnostic test accuracy meta-analysis. Ann Neurol 2016; 79(4): 625-35.
[http://dx.doi.org/10.1002/ana.24609] [PMID: 26833864]
[10]
Chen PH, Gao S, Wang YJ, Xu AD, Li YS, Wang D. Classifying ischemic stroke, from TOAST to CISS. CNS Neurosci Ther 2012; 18(6): 452-6.
[http://dx.doi.org/10.1111/j.1755-5949.2011.00292.x] [PMID: 22268862]
[11]
Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic stroke. Circ Res 2017; 120(3): 527-40.
[http://dx.doi.org/10.1161/CIRCRESAHA.116.308447] [PMID: 28154102]
[12]
Ntaios G, Sagris D, Strambo D, et al. Carotid atherosclerosis and patent foramen ovale in embolic stroke of undetermined source. J Stroke Cerebrovasc Dis 2021; 30(1): 105409.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105409] [PMID: 33137616]
[13]
Paraskevas KI, Gloviczki P, Antignani PL, et al. Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease. Prog Cardiovasc Dis 2022; 73: 41-7.
[http://dx.doi.org/10.1016/j.pcad.2022.05.003] [PMID: 35605696]
[14]
Delluc A, Malécot JM, Kerspern H, et al. Lipid parameters, lipid lowering drugs and the risk of venous thromboembolism. Atherosclerosis 2012; 220(1): 184-8.
[http://dx.doi.org/10.1016/j.atherosclerosis.2011.10.007] [PMID: 22035572]
[15]
Miranda B, Fonseca AC, Ferro JM. Patent foramen ovale and stroke. J Neurol 2018; 265(8): 1943-9.
[http://dx.doi.org/10.1007/s00415-018-8865-0] [PMID: 29680895]
[16]
Tateishi Y, Ueno Y, Tsujino A, et al. Cardiac and echocardiographic markers in cryptogenic stroke with incidental patent foramen ovale. J Stroke Cerebrovasc Dis 2021; 30(8): 105892.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105892] [PMID: 34107415]
[17]
Kamel H, Okin PM, Elkind MSV, Iadecola C. Atrial fibrillation and mechanisms of stroke. Stroke 2016; 47(3): 895-900.
[http://dx.doi.org/10.1161/STROKEAHA.115.012004] [PMID: 26786114]
[18]
Kamel H, Okin PM, Longstreth WT Jr, Elkind MSV, Soliman EZ. Atrial cardiopathy: A broadened concept of left atrial thromboembolism beyond atrial fibrillation. Future Cardiol 2015; 11(3): 323-31.
[http://dx.doi.org/10.2217/fca.15.22] [PMID: 26021638]
[19]
Yaghi S, Moon YP, Mora-McLaughlin C, et al. Left atrial enlargement and stroke recurrence: The Northern Manhattan Stroke Study. Stroke 2015; 46(6): 1488-93.
[http://dx.doi.org/10.1161/STROKEAHA.115.008711] [PMID: 25908460]
[20]
Hua-Guang Z, Yi-Long W, Qi-Dong C, Hui QU, Jian-Ke HU, Xiao-Chun Y. Risk of paradoxical embolism score in cryptogenic stroke patients or tansient ischemic attack with patent foramen ovale. Chinese Journal of Stroke 2013; 9(8): 654-62.
[21]
Jung JM, Lee JY, Kim HJ, et al. Patent foramen ovale and infarct volume in cryptogenic stroke. J Stroke Cerebrovasc Dis 2013; 22(8): 1399-404.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.034] [PMID: 23747019]
[22]
Sadrameli SS, Gadhia RR, Kabir R, Volpi JJ. Patent foramen ovale in cryptogenic stroke and migraine with aura: Does size matter? Cureus 2018; 10(8): e3213.
[http://dx.doi.org/10.7759/cureus.3213] [PMID: 30405989]
[23]
Turc G, Lee JY, Brochet E, Kim JS, Song JK, Mas JL. Atrial septal aneurysm, shunt size, and recurrent stroke risk in patients with patent foramen ovale. J Am Coll Cardiol 2020; 75(18): 2312-20.
[http://dx.doi.org/10.1016/j.jacc.2020.02.068] [PMID: 32381162]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy