Abstract
The comparative severity of patent foramen ovale (PFO)-related stroke in patients without atrial fibrillation (AF) and AF-related stroke in patients without PFO is unknown. Therefore, we compared the severity of PFO-related stroke and AF-related stroke. Twenty-six patients who underwent transesophageal echocardiography (TEE) were diagnosed with cardioembolic stroke from July 2018 to March 2020. Cases with AF detected by electrocardiograms or thrombus in the left atrium or left atrial appendage on TEE were included in the AF-related stroke group. Cases with a positive microbubble test on the Valsalva maneuver during TEE, and with no other factors that could cause stroke, were included in the PFO-related stroke group. This study was designed as a single-center, small population pilot study. The stroke severity of the two groups by the National Institute of Health Stroke Scale (NIHSS) score was compared by statistical analysis. Of the 26 cases, five PFO-related stroke patients and 21 AF-related stroke patients were analyzed. The NIHSS score was 2.2 ± 2.8 and 11.5 ± 9.2 (p-value < 0.01), the rate of hypertension was 20.0% and 85.7% (p-value = 0.01), and the HbA1c value was 5.5 ± 0.2% and 6.3 ± 1.3% (p-value = 0.02) in the PFO-related and AF-related stroke groups, respectively. Compared with AF-related stroke patients, stroke severity was low in PFO-related stroke patients.
Highlights
Stroke results in substantial disability and sometimes causes death [1]
In up to 40% of patients with acute ischemic stroke, there is a stroke of undetermined etiology in TOAST classification (5); this stroke has been labeled as cryptogenic stroke [1,2,4,5]
Patients with atrial fibrillation (AF) diagnosed from history, electrocardiogram (ECG) at admission, 24 h-holter ECG monitoring, ECG monitoring in the ward, or patients with thrombi including smoke-like echo with a swirling motion of blood in the left atrium (LA) or left atrial appendage (LAA), which is known to be a marker of a prothrombotic state, were classified as AF-related stroke patients [18]
Summary
Stroke results in substantial disability and sometimes causes death [1]. The TOAST classification denotes five subtypes of ischemic stroke: (1) large-artery atherosclerosis, (2) cardioembolism, (3) small-vessel occlusion, (4) stroke of other determined etiology, and (5) stroke of undetermined etiology [2]. Cardioembolic stroke accounts for 15–30% of ischemic strokes [3]. In up to 40% of patients with acute ischemic stroke, there is a stroke of undetermined etiology in TOAST classification (5); this stroke has been labeled as cryptogenic stroke [1,2,4,5]. Evaluation of stroke sources is important for preventing second stroke events
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