Patent foramen ovale

Innocent or guilty?: Evidence from a prospective population-based study

Irene Meissner, Bijoy K. Khandheria, John A. Heit, George W. Petty, Sheldon G. Sheps, Gary Lee Schwartz, Jack P. Whisnant, David O. Wiebers, Jody L. Covalt, Tanya M. Petterson, T. J H Christianson, Yoram Agmon

Research output: Contribution to journalArticle

266 Citations (Scopus)

Abstract

OBJECTIVES: We sought to determine the association between patent foramen ovale (PFO), atrial septal aneurysm (ASA), and stroke prospectively in a unselected population sample. BACKGROUND: The disputed relationship between PFO and stroke reflects methodologic weaknesses in studies using invalid controls, unblinded transesophageal echocardiography examinations, and data that are unadjusted for age or comorbidity. METHODS: The use of transesophageal echocardiography to identify PFO was performed by a single echocardiographer using standardized definitions in 585 randomly sampled, Olmsted County (Minnesota) subjects age 45 years or older participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. RESULTS: A PFO was identified in 140 (24.3%) subjects and ASA in 11 (1.9%) subjects. Of the 140 subjects with PFO, 6 (4.3%) had an ASA; of the 437 subjects without PFO, 5 had an ASA (1.1%, two-sided Fisher exact test, p = 0.028). During a median follow-up of 5.1 years, cerebrovascular events (cerebrovascular disease-related death, ischemic stroke, transient ischemic attack) occurred in 41 subjects. After adjustment for age and comorbidity, PFO was not a significant independent predictor of stroke (hazard ratio 1.46, 95% confidence interval 0.74 to 2.88, p = 0.28). The risk of a cerebrovascular event among subjects with ASA was nearly four times higher than that in those without ASA (hazard ratio 3.72, 95% confidence interval 0.88 to 15.71, p = 0.074). CONCLUSIONS: These prospective population-based data suggest that, after correction for age and comorbidity, PFO is not an independent risk factor for future cerebrovascular events in the general population. A larger study is required to test the putative stroke risk associated with ASA.

Original languageEnglish (US)
Pages (from-to)440-445
Number of pages6
JournalJournal of the American College of Cardiology
Volume47
Issue number2
DOIs
StatePublished - Jan 17 2006

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Patent Foramen Ovale
Aneurysm
Stroke
Population
Comorbidity
Transesophageal Echocardiography
Confidence Intervals
Cerebrovascular Disorders
Transient Ischemic Attack

ASJC Scopus subject areas

  • Nursing(all)

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Patent foramen ovale : Innocent or guilty?: Evidence from a prospective population-based study. / Meissner, Irene; Khandheria, Bijoy K.; Heit, John A.; Petty, George W.; Sheps, Sheldon G.; Schwartz, Gary Lee; Whisnant, Jack P.; Wiebers, David O.; Covalt, Jody L.; Petterson, Tanya M.; Christianson, T. J H; Agmon, Yoram.

In: Journal of the American College of Cardiology, Vol. 47, No. 2, 17.01.2006, p. 440-445.

Research output: Contribution to journalArticle

Meissner, I, Khandheria, BK, Heit, JA, Petty, GW, Sheps, SG, Schwartz, GL, Whisnant, JP, Wiebers, DO, Covalt, JL, Petterson, TM, Christianson, TJH & Agmon, Y 2006, 'Patent foramen ovale: Innocent or guilty?: Evidence from a prospective population-based study', Journal of the American College of Cardiology, vol. 47, no. 2, pp. 440-445. https://doi.org/10.1016/j.jacc.2005.10.044
Meissner, Irene ; Khandheria, Bijoy K. ; Heit, John A. ; Petty, George W. ; Sheps, Sheldon G. ; Schwartz, Gary Lee ; Whisnant, Jack P. ; Wiebers, David O. ; Covalt, Jody L. ; Petterson, Tanya M. ; Christianson, T. J H ; Agmon, Yoram. / Patent foramen ovale : Innocent or guilty?: Evidence from a prospective population-based study. In: Journal of the American College of Cardiology. 2006 ; Vol. 47, No. 2. pp. 440-445.
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abstract = "OBJECTIVES: We sought to determine the association between patent foramen ovale (PFO), atrial septal aneurysm (ASA), and stroke prospectively in a unselected population sample. BACKGROUND: The disputed relationship between PFO and stroke reflects methodologic weaknesses in studies using invalid controls, unblinded transesophageal echocardiography examinations, and data that are unadjusted for age or comorbidity. METHODS: The use of transesophageal echocardiography to identify PFO was performed by a single echocardiographer using standardized definitions in 585 randomly sampled, Olmsted County (Minnesota) subjects age 45 years or older participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. RESULTS: A PFO was identified in 140 (24.3{\%}) subjects and ASA in 11 (1.9{\%}) subjects. Of the 140 subjects with PFO, 6 (4.3{\%}) had an ASA; of the 437 subjects without PFO, 5 had an ASA (1.1{\%}, two-sided Fisher exact test, p = 0.028). During a median follow-up of 5.1 years, cerebrovascular events (cerebrovascular disease-related death, ischemic stroke, transient ischemic attack) occurred in 41 subjects. After adjustment for age and comorbidity, PFO was not a significant independent predictor of stroke (hazard ratio 1.46, 95{\%} confidence interval 0.74 to 2.88, p = 0.28). The risk of a cerebrovascular event among subjects with ASA was nearly four times higher than that in those without ASA (hazard ratio 3.72, 95{\%} confidence interval 0.88 to 15.71, p = 0.074). CONCLUSIONS: These prospective population-based data suggest that, after correction for age and comorbidity, PFO is not an independent risk factor for future cerebrovascular events in the general population. A larger study is required to test the putative stroke risk associated with ASA.",
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AU - Heit, John A.

AU - Petty, George W.

AU - Sheps, Sheldon G.

AU - Schwartz, Gary Lee

AU - Whisnant, Jack P.

AU - Wiebers, David O.

AU - Covalt, Jody L.

AU - Petterson, Tanya M.

AU - Christianson, T. J H

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