Aortic root dilatation in PFO-related cryptogenic stroke: A propensity score-matched analysis.

Abstract

Dilatation of the ascending aorta has an important role in the anatomical conformation of interatrial septum (IAS) especially when a patent foramen ovale (PFO) is present. The aim of the study was to investigate the relationship between ascending aortic dilation and PFO-related cryptogenic stroke in a cohort of cryptogenic strokes. It is a retrospective, single-center echocardiographic study assessing aortic root dilatation in 315 consecutive patients with cryptogenic stroke between January 2011 and January 2019. Aortic root dilatation was defined by a diameter of the Valsalva sinuses of the proximal aorta >40mm. Predictive factors of PFO were assessed by a multivariate analysis. Propensity score matching was applied to account for clinical differences. Of the 315 patients, 68 (22%) had an aortic root dilatation and 167 (53%) had a PFO. In the aortic root dilation group, PFO was more often diagnosed (n=47/68 [69%], vs n=120/247 [49%], P=.004). In the PFO group with aortic dilatation, IAS was more mobile (n=37/47[79%] vs n=69/120[57%], P<.012) and smaller (2.3±0.5 vs 2.5±0.5mm, P<.009). On multivariate analysis, aortic root dilatation (OR: 2.6; 95% CI [1.2-5.6]; P=.001) and IAS hypermobility (OR: 5.2 95% CI [2.7-10]; P=.001) were associated with PFO. After propensity matching, aortic root dilatation remained strongly associated with PFO (n=34/107 [32%] vs 15/107[14%], P=.002). Aortic root dilation and IAS hypermobility were strongly associated with PFO-related cryptogenic stroke.