Lack of association between right-to-left shunt and cerebral ischemia after adjustment for gender and age

Poppert Holger, Morschhaeuser Melanie, Feurer Regina, Bockelbrink Angelina, Schwarze Jens, Esposito Lorena, Heider Peter, Sander Dirk, Hemmer, Hemmer Bernhard

Description

A number of studies has addressed the possible association between patent foramen ovale (PFO) and stroke. However, the role of PFO in the pathogenesis of cerebral ischemia has remained controversial and most studies did not analyze patient subgroups stratified for gender, age and origin of stroke. Methods To address the role of PFO for the occurrence of cerebral ischemia, we investigated the prevalence of right-to-left shunt in a large group of patients with acute stroke or TIA. 763 consecutive patients admitted to our hospital with cerebral ischemia were analyzed. All patients were screened for the presence of PFO by contrast-enhanced transcranial Doppler sonography at rest and during Valsalva maneuver. Subgroup analyses were performed in patients stratified for gender, age and origin of stroke. Results A right-to-left shunt was detected in 140 (28%) male and in 114 (42%) female patients during Valsalva maneuver, and in 66 (13%) and 44 (16%) at rest respectively. Patients with right-to-left shunt were younger than those without ( P < 0.001). PFO was associated with stroke of unknown origin in male ( P = 0.001) but not female patients ( P > 0.05). After adjusting for age no significant association between PFO and stroke of unknown origin was found in either group. Conclusion Our findings argue against paradoxical embolization as a major cause of cerebral ischemia in patients with right-to-left shunt. Our data demonstrate substantial gender-and age-related differences that should be taken into account in future studies.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2008
• Nombre de lectures: 11
• Langue: English

Extrait

Journal of Negative Results in BioMedicine

BioMedCentral

Open Access Research Lack of association between right-to-left shunt and cerebral ischemia after adjustment for gender and age 1 11 Holger Poppert*, Melanie Morschhaeuser, Regina Feurer, 2 31 4 Angelina Bockelbrink, Jens Schwarze, Lorena Esposito, Peter Heider, 5 1 Dirk Sanderand Bernhard Hemmer

1 Address: Departmentof Neurology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Ismaningerstr. 22, 81675 Muenchen, Germany, 2 Department of Social Medicine, Epidemiology and Health Economics, Charité – University Medicine Berlin, Luisenstr. 57, 10117 Berlin, 3 4 Germany, Departmentof Neurology, Klinikum Chemnitz, Flemmingstraße 2, 09116 Chemnitz, Germany,Department of Vascular Surgery, 5 Klinikum Rechts der Isar, Technische Universitaet Muenchen Ismaninger Str. 22, 81675 Muenchen, Germany andNeurologische Klinik Medical Park Loipl, Thanngasse 15, 83483 Bischofswiesen, Germany Email: Holger Poppert*  [e-mail]; Melanie Morschhaeuser  [e-mail]; Regina Feurer  [e-mail]; Angelina Bockelbrink  [e-mail]; Jens Schwarze  [e-mail]; Lorena Esposito  [e-mail]; Peter Heider  heiderpeter@tonline.de; Dirk Sander  [e-mail]; Bernhard Hemmer  [e-mail]muenchen.de * Corresponding author

Published: 13 October 2008Received: 18 February 2008 Accepted: 13 October 2008 Journal of Negative Results in BioMedicine2008,7:7 doi:10.1186/1477-5751-7-7 This article is available from: http://www.jnrbm.com/content/7/1/7 © 2008 Poppert et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Introduction:A number of studies has addressed the possible association between patent foramen ovale (PFO) and stroke. However, the role of PFO in the pathogenesis of cerebral ischemia has remained controversial and most studies did not analyze patient subgroups stratified for gender, age and origin of stroke. Methods:To address the role of PFO for the occurrence of cerebral ischemia, we investigated the prevalence of right-to-left shunt in a large group of patients with acute stroke or TIA. 763 consecutive patients admitted to our hospital with cerebral ischemia were analyzed. All patients were screened for the presence of PFO by contrast-enhanced transcranial Doppler sonography at rest and during Valsalva maneuver. Subgroup analyses were performed in patients stratified for gender, age and origin of stroke. Results:A right-to-left shunt was detected in 140 (28%) male and in 114 (42%) female patients during Valsalva maneuver, and in 66 (13%) and 44 (16%) at rest respectively. Patients with right-to- left shunt were younger than those without (P< 0.001). PFO was associated with stroke of unknown origin in male (P= 0.001) but not female patients (P> 0.05). After adjusting for age no significant association between PFO and stroke of unknown origin was found in either group. Conclusion:Our findings argue against paradoxical embolization as a major cause of cerebral ischemia in patients with right-to-left shunt. Our data demonstrate substantial gender-and age- related differences that should be taken into account in future studies.

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