Cardiac and Echocardiographic Markers in Cryptogenic Stroke with Incidental Patent Foramen Ovale.

Some cardiac abnormalities could be a substrate for potential embolic source in cryptogenic stroke (CS). We evaluated whether cardiac and echocardiographic markers were associated with CS in patients with incidental patent foramen ovale (PFO) as defined using the Risk of Paradoxical Embolism (RoPE) score. Among 677 patients enrolled in a multicenter observational CS registry, 300 patients (44%) had PFOs detected by transesophageal echocardiography. They were classified into probable PFO-related stroke (RoPE score>6, n = 32) and stroke with incidental PFO (RoPE score≤6, n = 268) groups, and clinical characteristics, laboratory findings, cardiac and echocardiographic markers (i.e. brain natriuretic peptide, left atrial [LA] diameter, ejection fraction, early transmitral flow velocity/early diastolic tissue Doppler imaging velocity [E/e'], LA appendage flow velocity, spontaneous echo contrast, atrial septal aneurysm, substantial PFO, and aortic arch plaques), stroke recurrence, and excellent outcome (modified Rankin scale score <2) at discharge were compared. Risk factors for low RoPE scores were determined using multiple logistic regression analysis. Higher brain natriuretic peptide levels (p = 0.032), LA enlargement (p < 0.001), higher E/e' (p = 0.001), lower LA appendage flow velocity (p < 0.001), non-substantial PFO (p = 0.021), and aortic arch plaques (p = 0.002) were associated with the low RoPE score group. Patients with high RoPE scores had excellent outcomes (58% versus 78%, p = 0.035). LA enlargement (age- and sex-adjusted odds ratio, 1.15; 95 % confidence interval, 1.00-1.32; p = 0.039) was an independent predictor of low RoPE scores. Abnormal cardiac substrate could be associated with CS occurrence in a subset of patients with PFO. Patients with CS who had incidental PFO may be at risk of cardioembolism.

Tateishi Y ，Ueno Y ，Tsujino A ，Kuriki A ，Kamiya Y ，Shimizu T ，Doijiri R ，Yamaguchi E ，Kikuno M ，Shimada Y ，Takekawa H ，Koga M ，Ihara M ，Hirata K ，Hasegawa Y ，Toyoda K ，Hattori N ，Urabe T ，CHALLENGE ESUS/CS collaborators ... -  《-》

Biomarkers of Cardiac Dysfunction as Risk Factors in Cryptogenic Stroke.

It is unclear whether biomarkers of cardiac dysfunction are associated with cryptogenic stroke (CS). We retrospectively evaluated consecutive ischemic stroke patients. Patients underwent transthoracic echocardiography to evaluate left atrial diameter and the peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e'). Patent foramen ovale (PFO) and left atrial appendage flow velocity were evaluated by transesophageal echocardiography. We compared clinical characteristics and biomarkers of cardiac dysfunction (brain natriuretic peptide [BNP], left atrial diameter, E/e', and left atrial appendage flow velocity) between CS or CS without large PFO and other causative stroke subtypes. Among 1,514 patients with ischemic stroke, 264 patients were classified as having CS. Of these, transesophageal echocardiography revealed 27/158 (17%) large PFOs. In comparison, for the noncardioembolic stroke group, which consisted of large artery and small vessel subtypes, patients with CS without large PFO had higher log10 BNP (adjusted OR 2.70; 95% CI 1.92-3.78; p < 0.001), higher log10 E/e' (3.41; 1.21-13.15; p = 0.019), and lower left atrial appendage flow velocity (0.98; 0.97-1.00; p = 0.031). Left atrial diameter was similar for noncardioembolic stroke and CS without large PFO (p = 0.380). Cutoff values of BNP, E/e', and left atrial appendage flow velocity capable of distinguishing CS without large PFO from noncardioembolic stroke were 65.0 pg/mL (sensitivity 55.3%; specificity 70.9%), 13.0 (45.5%; 68.0%), and 46.0 cm/s (37.1%; 87.5%), respectively. Patients with CS without large PFO could have biomarkers of cardiac dysfunction.

Tateishi Y ，Kanamoto T ，Yamashita K ，Hirayama T ，Yoshimura S ，Miyazaki T ，Tsuneto A ，Maemura K ，Morofuji Y ，Horie N ，Izumo T ，Shiraishi H ，Tsujino A ... -  《-》

Left atrial enlargement as a maker of significant high-risk patent foramen ovale.

Rigatelli G ，Zuin M ，Adami A ，Aggio S ，Lanza D ，d'Elia K ，Braggion G ，Russo M ，Mazza A ，Roncon L ... -  《-》

Study of Transesophageal Echocardiography in Young Patients with Cryptogenic Stroke: Prevalence of Patent Foramen Ovale and Interpretation of the RoPE Score.

Arslan A ，Yılmaz DÇ ，Adıyaman M ，Kara C ，Örsçelik Ö ，Yılmaz IA ... -  《-》

Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale: analysis of putative high-risk features from the risk of paradoxical embolism database.

Wessler BS ，Thaler DE ，Ruthazer R ，Weimar C ，Di Tullio MR ，Elkind MS ，Homma S ，Lutz JS ，Mas JL ，Mattle HP ，Meier B ，Nedeltchev K ，Papetti F ，Di Angelantonio E ，Reisman M ，Serena J ，Kent DM ... -  《-》