PATENT FORAMEN OVALE IN PATIENTS WITH CEREBRAL INFARCTION - A TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY

Objectives: To determine the frequency of patent foramen ovale (PFO) a mong various subtypes of cerebral infarction. To determine whether any historical or clinical characteristics predict the presence or absenc e of PFO in these patients. Design: Comorbidity and infarct subtype st udy. Setting: Referral-based study. Patients: One hundred sixteen pati ents with cerebral infarction consecutively referred for transesophage al echocardiography during a 6-month period. Main Outcome Measures: In farct subtype classification was made using a clinical and radiographi c diagnostic rubric similar to that used by the Stroke Data Bank of th e National Institute of Neurological Diseases and Stroke. The frequenc y of various risk factors and clinical characteristics in patients wit h and in those without PFO and the frequency of PFO in patients with v arious infarct subtypes were compared (chi(2) or Fisher exact tests). Results: Patent foramen ovale was detected in 37 patients (32%). Mean age was similar in those with (60 years) and those without (64 years) PFO. Patent foramen ovale was more frequent among men (39%) than women (20%, P=.03). Patients with PFO had a lower frequency of atrial fibri llation, diabetes mellitus, hypertension, and peripheral vascular dise ase compared with those without PFO. There was no difference in freque ncy of the following characteristics in patients with PFO compared wit h those without PFO: pulmonary embolus, chronic obstructive pulmonary disease, pulmonary hypertension, peripheral embolism, prior cerebral i nfarction, nosocomial cerebral infarction, Valsalva maneuver at the ti me of cerebral infarction, recent surgery, or hemorrhagic transformati on of cerebral infarction. Patent foramen ovale was found in 22 (40%) of 55 patients with infarcts of uncertain cause and in 15 (25%) of 61 with infarcts of known cause (cardioembolic, 21%; large vessel atheros tenosis, 25%; lacune, 40%) (P=.08). When the analysis was restricted t o patients who underwent Valsalva maneuver, PFO with right to left or bidirectional shunt was found in 19 (50%) of 38 patients with infarcts of uncertain cause and in 6 (20%) of 30 with infarcts of known cause (P=.01). Conclusion: Although PFO was overrepresented in patients with infarcts of uncertain cause in our and other studies, it has a high f requency among patients with cerebral infarction of all types. The rel ation between PFO and stroke requires further study.