TY - JOUR
TI - Prevalence of patent foramen ovale in the Greek population is high and impacts on the interpretation of the risk of paradoxical embolism (RoPE) score
AU - Koutroulou, I.
AU - Tsivgoulis, G.
AU - Karacostas, D.
AU - Ikonomidis, I.
AU - Grigoriadis, N.
AU - Karapanayiotides, T.
JO - Therapeutic Advances in Neurological Disorders
PY - 2020
VL - 13
TODO - null
SP - null
PB - SAGE Publications Ltd
SN - 1756-2856, 1756-2864
TODO - 10.1177/1756286420964673
TODO - adult;  Article;  cerebrovascular accident;  computer assisted tomography;  controlled study;  female;  Greece;  Holter monitoring;  human;  major clinical study;  male;  middle aged;  middle cerebral artery;  National Institutes of Health Stroke Scale;  nuclear magnetic resonance imaging;  paradoxical embolism;  patent foramen ovale;  prevalence;  Rankin scale;  risk assessment;  risk of paradoxical embolism score;  transthoracic echocardiography;  Valsalva maneuver
TODO - Background: The risk of paradoxical embolism (RoPE) score calculates the probability that patent foramen ovale (PFO) is causally related to stroke (PFO attributable fraction, PFOAF), based on PFO prevalence in patients with cryptogenic stroke (CS) compared with that in the general population. The latter has been estimated at 25%; however, PFO prevalence in nonselected populations varies widely. Methods: Since PFO prevalence in Greece remains unknown, we evaluated it and we calculated PFOAF stratified by RoPE score in a cohort of patients with CS ⩽55 years old. PFO was detected according to the international consensus transcranial Doppler (TCD) criteria in 124 healthy subjects (H), in 102 patients with CS, and in 56 patients with stroke of known cause (nonCS). Each subject underwent unilateral middle cerebral artery recording after infusion of agitated saline, at rest, and after a controlled Valsalva maneuver. We characterized PFO as large (>20 microbubbles or curtain), moderate (11–20), and small (⩽10). Results: PFO was detected in 42.7% of H, 49% of CS, and 25% of nonCS (p = 0.013). Large PFOs were numerically higher in CS [28.4% (29/102)] compared with H [19.3% (24/124); p = 0.1] and to nonCS [7.1% (4/56), p = 0.04]. The median RoPE score in patients with CS and PFO was seven. Even patients with very high RoPE score (9–10) had moderate PFOAF (57%). For any individual stratum up to RopE score 8, PFOAF was <33%. Conclusions: PFO prevalence in the Greek population is much higher than the widely accepted 25%. PFO may be the cause of stroke in one out of nine Greek patients with CS. Among Greek CS patients who harbor a PFO, the latter is causal in one out of five. The established RoPE score cutoff of ⩾7 for having a probable PFO-associated stroke may overestimate the probability in patients deriving from populations with high PFO prevalence. © The Author(s), 2020.
ER -