Patent Foramen Ovale: Innocent or Guilty? Evidence from a Prospective Population-based Study.
From: Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA. meissner.irene@mayo.edu
Journal of the American College of Cardiology
- Publish Date: Jan 2006
- ISSN: 1558-3597
- Volume: 47
- Issue: 2
- Pages: 440-5
- Medium: Internet
- Language: English
- Citation (JAMA): Meissner Irene, Khandheria Bijoy K, Heit John A, et al. Patent Foramen Ovale: Innocent or Guilty? Evidence from a Prospective Population-based Study.. J. Am. Coll. Cardiol. Jan 2006;47:440-5
Abstract
OBJECTIVES: We sought to determine the association between patent foramen ovale (PFO), atrial septal aneurysm (ASA), and stroke prospectively in a unselected population sample. BACKGROUND: The disputed relationship between PFO and stroke reflects methodologic weaknesses in studies using invalid controls, unblinded transesophageal echocardiography examinations, and data that are unadjusted for age or comorbidity. METHODS: The use of transesophageal echocardiography to identify PFO was performed by a single echocardiographer using standardized definitions in 585 randomly sampled, Olmsted County (Minnesota) subjects age 45 years or older participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. RESULTS: A PFO was identified in 140 (24.3%) subjects and ASA in 11 (1.9%) subjects. Of the 140 subjects with PFO, 6 (4.3%) had an ASA; of the 437 subjects without PFO, 5 had an ASA (1.1%, two-sided Fisher exact test, p = 0.028). During a median follow-up of 5.1 years, cerebrovascular events (cerebrovascular disease-related death, ischemic stroke, transient ischemic attack) occurred in 41 subjects. After adjustment for age and comorbidity, PFO was not a significant independent predictor of stroke (hazard ratio 1.46, 95% confidence interval 0.74 to 2.88, p = 0.28). The risk of a cerebrovascular event among subjects with ASA was nearly four times higher than that in those without ASA (hazard ratio 3.72, 95% confidence interval 0.88 to 15.71, p = 0.074). CONCLUSIONS: These prospective population-based data suggest that, after correction for age and comorbidity, PFO is not an independent risk factor for future cerebrovascular events in the general population. A larger study is required to test the putative stroke risk associated with ASA.
Mesh Headings (Keywords): Aged, Cardiovascular Diseases, Comorbidity, Echocardiography, Transesophageal, Female, Heart Septal Defects, Atrial, Humans, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Risk Factors, Stroke, Venous Thrombosis
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