Endocardial Device Leads in Patients with Patent Foramen Ovale

Echocardiographic Correlates of Stroke/TIA and Mortality

Shiva P. Ponamgi, Vaibhav R. Vaidya, Christopher V. Desimone, Amit Noheria, David O. Hodge, Joshua P. Slusser, Naser M. Ammash, Charles J Bruce, Alejandro Rabinstein, Paul Andrew Friedman, Samuel J Asirvatham

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO. Methods: In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram. Results: Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447-2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95% CI 1.593-2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95% CI 1.351-1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up. Conclusions: In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StateAccepted/In press - 2017

Fingerprint

Patent Foramen Ovale
Transient Ischemic Attack
Stroke
Tricuspid Valve Insufficiency
Equipment and Supplies
Mortality
Ventricular Pressure
Blood Pressure
Confidence Intervals
Proportional Hazards Models
Aneurysm
Multivariate Analysis
Hemodynamics

Keywords

  • Defibrillator
  • Echocardiography
  • Leads
  • Pacemaker
  • Patent foramen ovale
  • Stroke
  • Transient ischemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Endocardial Device Leads in Patients with Patent Foramen Ovale : Echocardiographic Correlates of Stroke/TIA and Mortality. / Ponamgi, Shiva P.; Vaidya, Vaibhav R.; Desimone, Christopher V.; Noheria, Amit; Hodge, David O.; Slusser, Joshua P.; Ammash, Naser M.; Bruce, Charles J; Rabinstein, Alejandro; Friedman, Paul Andrew; Asirvatham, Samuel J.

In: PACE - Pacing and Clinical Electrophysiology, 2017.

Research output: Contribution to journalArticle

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title = "Endocardial Device Leads in Patients with Patent Foramen Ovale: Echocardiographic Correlates of Stroke/TIA and Mortality",
abstract = "Background: Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO. Methods: In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram. Results: Of 250 patients with a baseline echocardiogram, 9.6{\%} (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42{\%} (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95{\%} confidence interval [CI] 1.447-2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95{\%} CI 1.593-2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95{\%} CI 1.351-1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up. Conclusions: In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.",
keywords = "Defibrillator, Echocardiography, Leads, Pacemaker, Patent foramen ovale, Stroke, Transient ischemic attack",
author = "Ponamgi, {Shiva P.} and Vaidya, {Vaibhav R.} and Desimone, {Christopher V.} and Amit Noheria and Hodge, {David O.} and Slusser, {Joshua P.} and Ammash, {Naser M.} and Bruce, {Charles J} and Alejandro Rabinstein and Friedman, {Paul Andrew} and Asirvatham, {Samuel J}",
year = "2017",
doi = "10.1111/pace.12985",
language = "English (US)",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
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TY - JOUR

T1 - Endocardial Device Leads in Patients with Patent Foramen Ovale

T2 - Echocardiographic Correlates of Stroke/TIA and Mortality

AU - Ponamgi, Shiva P.

AU - Vaidya, Vaibhav R.

AU - Desimone, Christopher V.

AU - Noheria, Amit

AU - Hodge, David O.

AU - Slusser, Joshua P.

AU - Ammash, Naser M.

AU - Bruce, Charles J

AU - Rabinstein, Alejandro

AU - Friedman, Paul Andrew

AU - Asirvatham, Samuel J

PY - 2017

Y1 - 2017

N2 - Background: Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO. Methods: In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram. Results: Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447-2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95% CI 1.593-2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95% CI 1.351-1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up. Conclusions: In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.

AB - Background: Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO. Methods: In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram. Results: Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447-2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95% CI 1.593-2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95% CI 1.351-1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up. Conclusions: In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.

KW - Defibrillator

KW - Echocardiography

KW - Leads

KW - Pacemaker

KW - Patent foramen ovale

KW - Stroke

KW - Transient ischemic attack

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U2 - 10.1111/pace.12985

DO - 10.1111/pace.12985

M3 - Article

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

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