S-298 Recurrent stroke in relation to the grade of patent foramen ovale = S-298 Recurrent stroke in relation to the grade of patent foramen ovale

다국어 초록 (Multilingual Abstract)

Purpose: Previous studies have demonstrated a strong association between the presence of patent foramen ovale (PFO) and cryptogenic stroke. We aimed to investigate the relationship between the grade of PFO and recurrent stroke.?Methods: Consecutive 120 patients who underwent transesophageal echocardiography (TEE) for evaluation of cryptogenic stroke were retrospectively collected. Each stoke in all patients was classified as an index stroke and a recurrent stroke; the recurrent stoke was defined as a case which had definite history of previous stroke and/or showed old ischemic lesion on brain MR in addition to acute lesion. PFO was diagnosed by a cardiologist based on TEE using agitated-saline contrast and Valsalva maneuver. Quanti?cation of PFO was graded as 0 (no microbubbles), I (1-5 microbubbles), II (6-20 microbubbles), or III (＞20 microbubbles). We also reviewed conventional risk factors of ischemic stroke in all patients.?Results: A total of 96 patients (55±13 years, 66 men) were analyzed after excluding 34 patients who showed extracardiac shunt, interatrial septal defect, or nondiagnostic TEE. PFO was observed in 88 (92%) patients; 8 patients with grade 0, 16 with grade I, 35 with grade II, and 37 with grade III. Index stokes and recurrent strokes were observed in 59 and 37 patients, respectively. Risk factors of hypertension (n＝43), diabetes (n＝12), dyslipidemia (n＝25) and smoking (n＝30) were observed. Increasing grades of PFO was not related to the presence of recurrent stroke in the study patients (p＝0.118). In multivariate analysis including age, sex, PFO grading, and the risk factors, PFO grading was still not a significant predictor for recurrent stroke (odds ratio＝0.68, 95% confidence interval [CI]＝0.42-1.11). In the multivariate analysis, age, sex, and the risk factors were also not significant predictors for recurrent stroke (data not shown).?Conclusions: Despite a well-known association between the presence of PFO and cryptogenic stroke, the amount of shunt through PFO was not related to recurrent strokes in this study. The relationship between the grade of PFO and the recurrence of stroke needs large prospective study.