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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

Preliminary Investigation of In situ Thrombus Within Patent Foramen Ovale in Patients With and Without Stroke
This study uses high-resolution optical coherence tomography to investigate whether patent foramen ovale could be the site of thrombus formation in patients with or without stroke.
Source: JAMA - May 25, 2021 Category: General Medicine Source Type: research

Management of Patients With a Patent Foramen Ovale With History of Stroke or TIA
This Clinical Guidelines Synopsis summarizes the American Academy of Neurology ’s practice advisory update on management of patients with a patent foramen ovale who have a history of stroke or transient ischemic attack.
Source: JAMA - January 5, 2021 Category: General Medicine Source Type: research

Patent Foramen Ovale and Risk of Perioperative Stroke
To the Editor Dr Ng and colleagues reported that having a patent foramen ovale (PFO) diagnosed preoperatively was associated with an increased risk of stroke occurring within 30 days after noncardiac surgery. The diagnosis of PFO was made only by transthoracic or transesophageal echocardiography without any evaluation of the magnitude of right-to-left shunting. Moreover, presence and severity of atrial septal aneurysm was not recorded as a risk factor. Large or permanent right-to-left shunting graded either by transcranial Doppler or transthoracic echocardiography bubble test has been associated with an increased risk of p...
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Patent Foramen Ovale and Risk of Perioperative Stroke —Reply
In Reply Dr Rigatelli and Mr Zuin suggest the need to further characterize PFO to identify subgroups of the population with PFO who are at increased risk of perioperative stroke and hence, targets for preoperative optimization.
Source: JAMA - June 26, 2018 Category: General Medicine Source Type: research

Is Patent Foramen Ovale a Risk Factor for Perioperative Stroke?
Perioperative stroke is one of the most feared complications of any surgery or invasive medical procedure. Perioperative stroke occurs in less than 1% of patients undergoing general surgery, but the risk is several fold higher with cardiac surgery, carotid revascularization, other cerebrovascular procedures, and thoracic aortic repair. Given the volume of these interventions, perioperative and periprocedural stroke likely account for at least 5% of the approximately 800  000 strokes that occur each year in the United States, yet stroke in this setting remains understudied.
Source: JAMA - February 6, 2018 Category: General Medicine Source Type: research

Association of Preoperatively Diagnosed Patent Foramen Ovale With Perioperative Ischemic Stroke
This cohort study compares risk of ischemic stroke within 30 days postsurgery among adult noncardiac surgery patients with patent foramen ovale (PFO) vs without PFO.
Source: JAMA - February 6, 2018 Category: General Medicine Source Type: research

Reducing Recurrent Strokes
Adevice that reduces the risk of a second stroke in patients whose first may have resulted from a blood clot traveling through a patent foramen ovale (PFO) and on to the brain has received FDA approval.
Source: JAMA - January 3, 2017 Category: Journals (General) Source Type: research