Population-based study of the relationship between patent foramen ovale and cerebrovascular ischemic events.

OBJECTIVE To determine whether patent foramen ovale (PFO) is a risk factor for a cryptogenic cerebrovascular ischemic event (CIE). METHODS This case-control study of 1072 residents of Olmsted County, Minnesota, who underwent contrast transesophageal echocardiography between 1993 and 1997 included 519 controls without CIE randomly selected from the population, 262 controls without CIE referred for transesophageal echocardiography because of cardiac disease, 158 cases with incident CIE of obvious cause (noncryptogenic), and 133 cases with incident CIE of uncertain cause (cryptogenic). RESULTS Large PFOs were detected in 108 randomly selected controls (20.8%), 22 referred controls (8.4%), 17 noncryptogenic CIE cases (10.8%), and 22 cryptogenic CIE cases (16.5%). After adjustment for age, sex, hypertension, smoking, atrial fibrillation, ischemic heart disease, and number of contrast injections, the presence of a large PFO was not significantly associated with group status (P=.07). Using the odds of the presence of large PFO in the randomly selected controls as the reference, the odds ratio (95% confidence interval) of the presence of large PFO was 0.47 (0.26-0.87) for referred controls, 0.69 (0.37-1.29) for noncryptogenic CIE cases, and 1.10 (0.63-1.90) for cryptogenic CIE cases. CONCLUSIONS Patent foramen ovale is not a risk factor for cryptogenic ischemic stroke or transient ischemic attack in the general population. The PFO's importance in the genesis of cryptogenic CIE may have been overestimated in previous studies because of selective referral of cases and underascertainment of PFO among comparison groups of patients referred for echocardiography for clinical indications other than cryptogenic CIE.

[1]  D. Wiebers,et al.  Atherosclerosis of the aorta: risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study. , 2004, Journal of the American College of Cardiology.

[2]  M. Hillbom,et al.  Factor V Leiden and prothrombin gene mutation may predispose to paradoxical embolism in subjects with patent foramen ovale , 2003, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[3]  J. Seward,et al.  Comparison of frequency of patent foramen ovale by transesophageal echocardiography in patients with cerebral ischemic events versus in subjects in the general population. , 2001, The American journal of cardiology.

[4]  W. O'Fallon,et al.  Predictors of Cerebrovascular Events and Death Among Patients With Valvular Heart Disease: A Population-Based Study , 2000, Stroke.

[5]  B Meier,et al.  Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. , 2000, Circulation.

[6]  A. Pancioli,et al.  Incidence rates of first-ever ischemic stroke subtypes among blacks: a population-based study. , 1999, Stroke.

[7]  W M O'Fallon,et al.  Ischemic stroke subtypes: a population-based study of incidence and risk factors. , 1999, Stroke.

[8]  C. Mullany,et al.  Surgical patent foramen ovale closure for prevention of paradoxical embolism-related cerebrovascular ischemic events. , 1999, Circulation.

[9]  M. Enriquez-Sarano,et al.  Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC study. Stroke Prevention: Assessment of Risk in a Community. , 1999, Mayo Clinic proceedings.

[10]  K. Bailey,et al.  Detection and control of high blood pressure in the community : Do we need a wake-up call? , 1999, Hypertension.

[11]  J. Seward,et al.  Frequency of atrial septal aneurysms in patients with cerebral ischemic events. , 1999, Circulation.

[12]  B. Cujec,et al.  Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks. , 1999, The Canadian journal of cardiology.

[13]  W. O'Fallon,et al.  Survival and recurrence after first cerebral infarction , 1998, Neurology.

[14]  J. Whisnant,et al.  Patent foramen ovale in patients with cerebral infarction. A transesophageal echocardiographic study. , 1997, Archives of neurology.

[15]  B. Norrving,et al.  Cardiac changes in stroke patients and controls evaluated with transoesophageal echocardiography. , 1997, Scandinavian cardiovascular journal : SCJ.

[16]  W M O'Fallon,et al.  Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. , 1996, Stroke.

[17]  L. Melton,et al.  History of the Rochester Epidemiology Project. , 1996, Mayo Clinic proceedings.

[18]  W. O'Fallon,et al.  Mitral valve prolapse and the risk of stroke after initial cerebral ischemia , 1995, Neurology.

[19]  B. Norrving,et al.  Carotid artery and heart disease in subtypes of cerebral infarction. , 1994, Stroke.

[20]  A. Tonkin,et al.  Evidence that patent foramen ovale is not a risk factor for cerebral ischemia in the elderly. , 1994, The American journal of cardiology.

[21]  R. Sacco,et al.  Characteristics of Patent Foramen Ovale Associated With Cryptogenic Stroke: A Biplane Transesophageal Echocardiographic Study , 1994, Stroke.

[22]  A. Bolger,et al.  Transesophageal Echocardiographic Findings in Stroke Subtypes , 1994, Stroke.

[23]  A. Labovitz,et al.  Usefulness of transesophageal echocardiography in unexplained cerebral ischemia. , 1993, The American journal of cardiology.

[24]  F. Chédru,et al.  Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study Using Transesophageal Echocardiography , 1993, Stroke.

[25]  R. Sacco,et al.  Patent foramen ovale: a new risk factor for ischemic stroke. , 1993, Heart disease and stroke : a journal for primary care physicians.

[26]  R. Sacco,et al.  Patent Foramen Ovale as a Risk Factor for Cryptogenic Stroke , 1992, Annals of Internal Medicine.

[27]  J. Broderick,et al.  Relationship of Cardiac Disease to Stroke Occurrence, Recurrence, and Mortality , 1992, Stroke.

[28]  A. Camm,et al.  Risk of patent foramen ovale for thromboembolic events in all age groups. , 1992, The American journal of cardiology.

[29]  J. Bogousslavsky,et al.  [Patent foramen ovale and cerebral infarct in young patients]. , 1990, Schweizerische medizinische Wochenschrift.

[30]  L. Melton,et al.  Comparison of case ascertainment by medical record linkage and cohort follow-up to determine incidence rates for transient ischemic attacks and stroke. , 1990, Journal of clinical epidemiology.

[31]  D. Hosmer,et al.  Applied Logistic Regression , 1991 .

[32]  H. J. Smith,et al.  PATENT FORAMEN OVALE IN YOUNG STROKE PATIENTS , 1988, The Lancet.

[33]  P. Lechat,et al.  Prevalence of patent foramen ovale in patients with stroke. , 1988, The New England journal of medicine.

[34]  J. Seward,et al.  Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. , 1985, Journal of the American College of Cardiology.

[35]  P. Wolf,et al.  The Pilot Stroke Data Bank: Definition, Design, and Data , 1984, Stroke.