Clinical and trans-esophageal echocardiographic evaluation of patent foramen ovale in young Iraqi patients with ischemic stroke

Abstract

Background: Patent  foramen ovale (PFO) has been Jong identified as a potential risk factor for stroke,  but the mechanism   or mechanisms   of PFO-associated    stroke remain  unsettled  and controversial   till now.

Aim:  To evaluate  possible  differences   in stroke risk  factors  and stroke patterns  between patients  with  and without  PFO using trans-esophageal   echocardiographic    study that  may give clues to the mechanism   of PFO-associated   stroke that  is mainly  seen in young people.

Methods:  This short-term cross-sectional observational   study involved  95 consecutive young cryptogenic stroke  patients. The study was conducted at the Baghdad Teaching  Hospital from January  2003  to February  2006.  The presence  of PFO was  assessed  by trans-esophageal echocardiography (TEE).

Results:  Of the 95 stroke patients, 32 (33.68%)  had PFO. Patients  with PFO were younger (OR, 0.95; 95% CI, 0.93 to 0.97) and less likeiy to have traditional risk factors such as hypertension   (OR,  0.49; 95% CI, 0.28 to 0.85), hypercholesterolemia    (OR, 0.56; 95%  CIL, 0.34 t0 0.93), or current smoking  (OR, 0.67; 95% CI. 0.47 to 0.97). Features suggestive of paradoxical   embolism,  such as Valsalva-provoking    activities  (by careful  history  taking)  or deep vein thrombosis were not more frequent  in patients  with PFO.

Ceonelusions:  Differences   in stroke risk  factors and stroke  patterns  suggest  that  different stroke mechanisms   occur in patients  with and without PFO.