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Incidence of atrial fibrillation in cryptogenic stroke with patent foramen ovale closure: protocol for the prospective, observational PFO-AF study
Introduction After closure of patent foramen ovale (PFO) due to stroke, atrial fibrillation (AF) occurs in up to one in five patients. However, data are sparse regarding the possible pre-existence of AF in these patients prior to PFO closure, and about recurrence of AF in the long term after the procedure. No prospective study to date has investigated these topics in patients with implanted cardiac monitor (ICM). The PFO-AF study (registered with ClinicalTrials.gov under the number NCT04926142) will investigate the incidence of AF occurring within 2 months after percutaneous closure of PFO in patients with prior stroke. AF...
Source: BMJ Open - September 12, 2023 Category: General Medicine Authors: Badoz, M., Derimay, F., Serzian, G., Besutti, M., Rioufol, G., Frey, P., Guenancia, C., Ecarnot, F., Meneveau, N., Chopard, R. Tags: Open access, Cardiovascular medicine Source Type: research

Patent foramen ovale leading to mismanagement in a mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke ‐like episodes patient
We report the clinical, imaging, echocardiography and muscle biopsy findings of a patient presenting by unique characteristics which have not been reported in previous cases of MELAS. The reported case is a 34  year old man with the history of three times hospitalization due to muscle weakness, encephalopathy, progressive cognitive decline, and gradual visual loss. Muscle biopsy revealed Ragged Red Fibers concomitant with mitochondrial disorders. PFO was found in echocardiography leading to mismanagemen t of this patient and MR imaging showed ischemic lesions with a progressive pattern. This is the first reported case of...
Source: Clinical Case Reports - July 21, 2023 Category: General Medicine Authors: Mehri Salari, Masoud Etemadifar, Ronak Rashedi, Romina Rashedi Tags: CASE REPORT Source Type: research

Transcranial Doppler Screening for Patent Foramen Ovale Closure in Cryptogenic Strokes in Young: A Single Center Experience from South India
CONCLUSIONS: R-L shunt is common in cryptogenic ischemic strokes in young. TCD with bubble contrast study is a noninvasive and feasible bedside tool to detect them. Applying the ESUS criteria in these cryptogenic strokes with a positive TCD bubble contrast study can be then used for selecting patients for more invasive tests like TEE. High-risk PFOs picked up with TEE can be then considered for PFO closure for secondary stroke prevention. The history of Valsalva maneuver-like activity (such as lifting heavy weights or straining) at the time of stroke onset can be a clinical predictor for the presence of an R-L shunt. In ad...
Source: Journal of the Association of Physicians of India - June 25, 2023 Category: General Medicine Authors: Deepti Bal Atif Iqbal Ahmed Shaikh Murali Rayani Sanjith Aaron Viji Samuel Thompson John Jose Jesu Krupa Rohit Ninan Benjamin Joanne Lydia Rajkumar Appaswamy Thirumal Prabhakar Source Type: research

Use of the insertable Holter with remote detection in the etiological diagnosis of cryptogenic stroke: Analysis of 73 patients
CONCLUSIONS: The presence of high-density supraventricular tachycardia can be indicative for predicting silent AF. No other variables have been observed that allow us to predict detection of AF in these patients.PMID:37055252 | DOI:10.1016/j.medcli.2023.03.005
Source: Medicina Clinica - April 13, 2023 Category: General Medicine Authors: Paula Lobato Casado Álvaro Jamilena López Jose Clemente Segundo Rodr íguez Marta Inmaculada Pach ón Iglesias Mar ía Del Mar Morín Martín Miguel Ángel Arias Palomares Source Type: research

Platypnoea orthodeoxia syndrome and its association with cryptogenic ischaemic stroke
J R Coll Physicians Edinb. 2023 Mar 4:14782715231159470. doi: 10.1177/14782715231159470. Online ahead of print.ABSTRACTPlatypnoea orthodeoxia syndrome is a rare condition, which can be present in patients with patent foramen ovale (PFO). In this case, a 72-year-old lady presented to the emergency department with a cryptogenic stroke associated with right thalamic infarct. While in hospital, it was noticed that the patient had desaturations in the upright position, and these improved in the recumbent position, consistent with platypnoea orthodeoxia syndrome. The patient was found to have a PFO, which was then closed, and he...
Source: Journal of the Royal College of Physicians of Edinburgh - March 4, 2023 Category: General Medicine Authors: Abdul Salam Snigdhendu Mandal Samaah Fathima Sripriya Rasthapuram Krishnakumar Radhakrishnan Source Type: research

Echocardiographic Measures of Left Atrial Function and Size and Incident Dementia
To the Editor A recent study described a significant association between left atrial function and an increased risk of subsequent dementia, independent of the presence of atrial fibrillation. These findings are similar to our 2009 study, which examined subclinical left atrial dysfunction and risk of stroke in patients with patent foramen ovale (PFO). We found that impairment of reservoir, conduit, and contractile strain and impairment of emptying, passive emptying, and active emptying fraction was present in patients with multiple ischemic events, PFO, and atrial septal aneurysm compared with healthy individuals. After PFO...
Source: JAMA - July 19, 2022 Category: General Medicine Source Type: research

Treatment Effects in Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale
To the Editor In a recent study, Dr Kent and colleagues used previously developed scoring systems to estimate the risk of recurrent ischemic stroke in patients with patent foramen ovale (PFO) and concluded that the risk reduction for recurrent ischemic events with device closure varied across groups classified by their probabilities that the stroke was causally related to the PFO. Although these findings are interesting, they should be considered cautiously because other than right-to-left shunt and atrial septal aneurysm, no groups were stratified using anatomical and/or functional PFO variables. However, the magnitude of...
Source: JAMA - April 12, 2022 Category: General Medicine Source Type: research

Treatment Effects in Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale —Reply
In Reply We agree with Drs Rigatelli and Zuin that the PFO-Associated Stroke Causal Likelihood (PASCAL) Classification System used in our study does not include every attribute of potential relevance to the causal relatedness of a discovered PFO to an index stroke, such as Eustachian valve prominence or tunnel length. We would add to their list of PASCAL-omitted variables with a putative association with paradoxical embolism: Valsalva at stroke onset, recent history of prolonged immobility, history of sleep apnea, and presence of venous thrombophilia, to mention only a few.
Source: JAMA - April 12, 2022 Category: General Medicine Source Type: research

Data Plotted Incorrectly in Figure 2
This article was corrected online.
Source: JAMA - January 25, 2022 Category: General Medicine Source Type: research

Patent Foramen Ovale Closure —Harnessing Clinical Trial Evidence to Inform Individualized Treatment Decisions
According to some estimates, approximately one-quarter of the general US population has a patent foramen ovale (PFO). With such a high prevalence, clinicians frequently attempt to determine whether a PFO has had a causal role among patients who experience an unexplained stroke, and whether closing the PFO might reduce the risk of recurrent stroke. Several randomized clinical trials have compared the outcomes of PFO closure vs treatment with antiplatelet or anticoagulation agents. In 2016, the American Academy of Neurology conducted a systematic review of 3 trials and concluded that clinicians “should not routinely offer ...
Source: JAMA - December 14, 2021 Category: General Medicine Source Type: research

Heterogeneity of Treatment Effect
This Guide to Statistics and Methods discusses the various approaches to estimating variability in treatment effects, including heterogeneity of treatment effect, which was used to assess the association between surgery to close patent foramen ovale and risk of recurrent stroke in patients who presented with a stroke in a related JAMA article.
Source: JAMA - December 14, 2021 Category: General Medicine Source Type: research

Analysis of Pooled Individual Patient Data From RCTs of Device Closure of PFO After Stroke
This study evaluates heterogeneity of treatment effect (HTE) of patent foramen ovale (PFO) closure on stroke recurrence based on the Risk of Paradoxical Embolism and PFO-Associated Stroke Causal Likelihood scoring systems using individual patient data pooled from 6 randomized clinical trials (RCTs) that compared PFO closure plus medical therapy vs medical therapy alone in patients with PFO-associated stroke.
Source: JAMA - December 14, 2021 Category: General Medicine Source Type: research

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