AUTHOR=Kahles Timo , Michel Patrik , Hapfelmeier Alexander , Eberli Franz R. , Zedde Marialuisa , Thijs Vincent , Kraemer Markus , Engelter Stefan T. , Serena Joaquin , Weimar Christian , Mallmann Achim , Luft Andreas , Hemelsoet Dimitri , Thaler David E. , Müller-Eichelberg Andreas , De Pauw Adinda , Sztajzel Roman , Armon Carmel , Kent David M. , Meier Bernhard , Mattle Heinrich P. , Fischer Urs , Arnold Marcel , Mono Marie-Luise , Nedeltchev Krassen ,  for the International PFO Consortium NCT00859885 

TITLE=Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors

JOURNAL=Frontiers in Neurology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00503

DOI=10.3389/fneur.2020.00503

ISSN=1664-2295

ABSTRACT=<p><bold>Background and Purpose:</bold> To identify factors associated with prior stroke at presentation in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO).</p><p><bold>Methods:</bold> We studied cross-sectional data from the International PFO Consortium Study (NCT00859885). Patients with first-ever stroke and those with prior stroke at baseline were analyzed for an association with PFO-related (right-to-left shunt at rest, atrial septal aneurysm, deep venous thrombosis, pulmonary embolism, and Valsalva maneuver) and PFO-unrelated factors (age, gender, BMI, hypertension, diabetes mellitus, hypercholesterolemia, smoking, migraine, coronary artery disease, aortic plaque). A multivariable analysis was used to adjust effect estimation for confounding, e.g., owing to the age-dependent definition of study groups in this cross-sectional study design.</p><p><bold>Results:</bold> We identified 635 patients with first-ever and 53 patients with prior stroke. Age, BMI, hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease, and right-to-left shunt (RLS) at rest were significantly associated with prior stroke. Using a pre-specified multivariable logistic regression model, age (Odds Ratio 1.06), BMI (OR 1.06), hypercholesterolemia (OR 1.90) and RLS at rest (OR 1.88) were strongly associated with prior stroke.Based on these factors, we developed a nomogram to illustrate the strength of the relation of individual factors to prior stroke.</p><p><bold>Conclusion:</bold> In patients with CS and PFO, the likelihood of prior stroke is associated with both, PFO-related and PFO-unrelated factors.</p>