Patent foramen ovale increases the risk of acute ischemic stroke in patients with acute pulmonary embolism leading to right ventricular dysfunction

• Published in: Thrombosis research 2014-11, Vol.134 (5), p.1052-1056
• Main Authors: Goliszek, Sylwia, Wiśniewska, Małgorzata, Kurnicka, Katarzyna, Lichodziejewska, Barbara, Ciurzyński, Michał, Kostrubiec, Maciej, Gołębiowski, Marek, Babiuch, Marek, Paczynska, Marzanna, Koć, Marcin, Palczewski, Piotr, Wyzgał, Anna, Pruszczyk, Piotr
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brain - pathology; Brain Ischemia - complications; Brain Ischemia - etiology; Brain Ischemia - pathology; Diffusion Magnetic Resonance Imaging; Echocardiography; Female; Foramen Ovale, Patent - complications; Foramen Ovale, Patent - pathology; Heart Ventricles - pathology; Hematology, Oncology and Palliative Medicine; Humans; ischemic stroke; Male; Middle Aged; patent foramen ovale; pulmonary embolism; Pulmonary Embolism - complications; Pulmonary Embolism - pathology; right ventricular dysfunction; Risk Factors; Stroke - complications; Stroke - etiology; Stroke - pathology; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - pathology; Young Adult
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2014.09.013

Abstract Background Patent foramen ovale (PFO) is an established risk factor for ischemic stroke. Since acute right ventricular dysfunction (RVD) observed in patients with PE can lead to right-to-left inter-atrial shunt via PFO, we hypothesized that PFO is a risk factor for ischemic stroke in PE with significant right ventricular dysfunction. Methods 55 patients (31 F, 24 M), median age 49 years (range 19–83 years) with confirmed PE underwent echocardiography for RVD and PFO assessment. High risk acute PE was diagnosed in 3 (5.5%) patients, while 16 (29%) hemodynamically stable with RVD patients formed a group with intermediate-risk PE. PFO was diagnosed in 19 patients (34.5%). Diffusion-weighted MRI of the brain for acute ischemic stroke (AIS) was performed in all patients 4.91 ± 4.1 days after admission. Results AIS was detected by MRI in 4 patients (7.3%). Only one stroke was clinically overt and resulted in hemiplegia. All 4 AIS occurred in the PFO positive group (4 of 19 patients), and none in subjects without PFO (21.0% vs 0%, p = 0.02). Moreover, all AIS occurred in patients with RVD and PFO, and none in patients with PFO without RVD (50% vs 0%, p = 0.038). Conclusion Our data suggest that acute pulmonary embolism resulting in right ventricular dysfunction may lead to acute ischemic stroke in patients with patent foramen ovale. However, the clinical significance of such lesions remains to be determined.