Cardiology Letters 2025, 34(2):84-92

Risk profile of anatomical and functional parameters of patent foramen ovale and associated anatomical structures in patients with cryptogenic stroke or transient ischemic attack

Juraj Dúbrava¹, Rastislav Šidlo²

¹ Department of Noninvasive Cardiology, University Hospital Bratislava, Slovakia

² Faculty of Economic Informatics, University of Economics, Bratislava, Slovakia

Background: This study evaluated the risk profile of patent foramen ovale (PFO) parameters and associated structures for cryptogenic cerebrovascular (CV) accidents.

Methods: We enrolled prospectively 1270 consecutive patients who underwent contrast transesophageal echocardiography: 702 patients with cryptogenic stroke (CS) or transient ischemic attack (TIA) and 568 controls without CV accidents. In this study, we evaluated the patients diagnosed with PFO. We compared 224 patients with CS or TIA and PFO (31.9%) to 106 controls with the incidental finding of a PFO (18.7%). Diameter and length of the PFO, large PFO (diameter ≥ 4 mm), long PFO (length ≥ 10 mm), shunt presence without Valsalva maneuver, shunt severity, atrial septal aneurysm (ASA; septal excursion ≥ 15 mm), atrial septal defect, and Eustachian valve/Chiari network were assessed.

Results: All characteristics of PFO significantly increased relative risk (RR) of CS/TIA vs population without PFO [RR (95%CI)] - PFO: 2.04 (1.57;2.66); p<0.001, large PFO: 4.99 (2.66;9.39); p<0.001, PFO with diameter ≥ median 2.4 mm: 3.20 (2.19;4.68); p<0.001, long PFO: 2.25 (1.65;3.06); p<0.001, PFO with length ≥ median 12 mm: 2.26 (1.61;3.17); p<0.001, moderate or large shunt: 2.25 (1.65;3.08); p<0.001, shunt present without Valsalva maneuver: 2.47 (1.74;3.52); p<0.001. PFO diameter ≥ median 2.4 mm and long PFO were identified in a multivariate logistic regression analysis as significant risk factors of CS/TIA - 2.43 (1.58;3.74) ;p<0.001 and 1.46 (1.02; 2.08); p<0.05, respectively. In contrast, ASA, PFO+ASA, atrial septal defect, Eustachian valve/Chiari network each did not increase the risk of CV accidents vs population without respective structure.

Conclusions: Out of the PFO parameters a large diameter most significantly increased the risk of CS/TIA. Long PFO, shunt presence without Valsalva maneuver and moderate/large shunt also significantly increased the risk. The atrial septal or right atrial structures potentially associated with PFO did not increase the risk.

Keywords: patent foramen ovale; cryptogenic stroke; transesophageal echocardiography atrial septal aneurysm

Published: February 1, 2025  Show citation