Differences in clinical and biological factors between patients with PFO-related stroke and patients with PFO and no cerebral vascular events

Raluca Ştefania Badea; Athena Cristina Ribigan; Nicolae Grecu; Elena Terecoasǎ; Florina Anca Antochi; Sorina Bâldea Mihǎilǎ; Cristina Tiu; Bogdan Ovidiu Popescu

doi:10.3389/fneur.2023.1104674

Differences in clinical and biological factors between patients with PFO-related stroke and patients with PFO and no cerebral vascular events

Front Neurol. 2023 Mar 14:14:1104674. doi: 10.3389/fneur.2023.1104674. eCollection 2023.

Authors

Raluca Ştefania Badea^{1

2}, Athena Cristina Ribigan^{1

2}, Nicolae Grecu², Elena Terecoasǎ^{1

2}, Florina Anca Antochi^{1

2}, Sorina Bâldea Mihǎilǎ^{3

4}, Cristina Tiu^{1

2}, Bogdan Ovidiu Popescu^{1

5}

Affiliations

¹ Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
² Neurology Department, University Emergency Hospital of Bucharest, Bucharest, Romania.
³ Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
⁴ Cardiology and Cardiovascular Surgery Department, University and Emergency Hospital, Bucharest, Romania.
⁵ Neurology Department, Colentina Clinical Hospital, Bucharest, Romania.

Abstract

Background: While stroke is one of the most dissected topics in neurology, the primary prevention of PFO-related stroke in young patients is still an unaddressed subject. We present a study concerning clinical, demographic, and laboratory factors associated with stroke and transient ischemic attack in patients with patent foramen ovale (PFO), as well as comparing PFO-patients with and without cerebrovascular ischemic events (CVEs).

Patients and methods: Consecutive patients with PFO-associated CVEs were included in the study; control group was selected from patients with a PFO and no history of stroke. All participants underwent peripheral routine blood analyses, as well as, on treating physician's recommendations, screening for thrombophilia.

Results: Ninety-five patients with CVEs and 41 controls were included. Females had a significantly lower risk of CVEs than males (p = 0.04). PFO size was similar between patients and controls. Patients with CVEs had more often hypertension (n = 33, 34.7%), p = 0.007. No significant differences were found between the two groups with regard to routine laboratory tests and thrombophilia status. Hypertension and gender were identified in a binomial logistic regression model as independent predictors for CVEs, but with an area under the ROC curve of 0.531, suggesting a very poor level of discrimination between the two groups.

Discussion and conclusions: There is little difference between patients with PFO with and without CVEs in terms of PFO size and routine laboratory analyses. While still a controversial topic in the specialty literature, classic first-level thrombophilic mutations are not a risk factor for stroke in patients with PFO. Hypertension and male gender were identified as factors associated with a higher risk of stroke in the setting of PFO.

Keywords: PFO (patent foramen ovale); PFO-associated stroke; Spencer logarithmic scale; primary prevention; thrombophilia.