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Patent foramen ovale and stroke in intermediate-risk pulmonary embolism.
Chest. 2014 May 29;
Authors: Doyen D, Castellani M, Moceri P, Chiche O, Lazdunski R, Bertora D, Cerboni P, Chaussade C, Ferrari E
Abstract
ABSTRACT BACKGROUND: Patent foramen ovale (PFO) in pulmonary embolism (PE) is associated with an increased risk of complications. However, little is known about PFO and ischemic stroke prevalences, particularly in acute intermediate-risk pulmonary embolism. In addition, in this context, the so-called "gold standard" method of PFO diagnosis remains unknown.
OBJECTIVES: We aimed to evaluate PFO and ischemic stroke prevalences, and determine which of transoesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) is the best PFO diagnostic method in this context.
METHODS: We conducted a prospective monocentric study including consecutive intermediate-risk PE patients in whom a TEE and TTE with contrast were performed. Brain magnetic resonance imaging was used to confirm clinically obvious strokes or to diagnose subclinical ones.
RESULTS: Forty-one intermediate-risk PE patients were identified over a 9-month period. Contrast TEE revealed PFO in 56.1% of our population, whereas contrast TTE showed PFO in only 19.5% of patients (P < .001). To note, all PFO observed with TTE were also diagnosed by TEE. Ischemic stroke occurred in 17.1%, and were always associated with PFO and large shunt.
CONCLUSIONS: PFO and related ischemic strokes are frequent in intermediate-risk pulmonary embolism. TEE is much more efficient than TTE for PFO diagnostic. Considering the high risk of intra-cranial bleeding with thrombolysis in PE, which in part may be due to haemorrhagic transformation of sub-clinical strokes, screening PFO with TEE should be considered in intermediate risk PE when a thrombolytic treatment is discussed.
PMID: 24874409 [PubMed - as supplied by publisher]