Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?
Identifieur interne : 001C62 ( Istex/Corpus ); précédent : 001C61; suivant : 001C63Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?
Auteurs : Gianluca Rigatelli ; Fabio Dell'Avvocata ; Massimo Giordan ; Gabriele Braggion ; Silvio Aggio ; Mauro Chinaglia ; Loris Roncon ; Paolo Cardaioli ; Jack P. ChenSource :
- Journal of Interventional Cardiology [ 0896-4327 ] ; 2009-08.
Abstract
Background: Large patent foramen ovale (PFO), spontaneous right‐to‐left shunt, large atrial septal aneurysm (ASA), coagulation abnormalities, and prominent eustachian valve (EV) have all been independently suggested as risk factors for recurrent stroke. We sought to retrospectively evaluate risk of stroke and impact of transcatheter PFO closure in patients with concurrent large PFO, spontaneous right‐to‐left shunt, large ASA, coagulation abnormalities, and prominent EV. Methods: Between March 2006 and October 2008, 36 (mean age 44 ± 10.9 years, 28 females) out of 120 consecutive patients referred to our center for transcatheter PFO closure had concomitant diagnosis of (a) large PFO on transcranial Doppler (TCD) and transesophageal echocardiography (TEE), (b) spontaneous right‐to‐left shunt on TCD, (c) large ASA, (d) prominent EV, and (e) coagulation abnormalities. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative TEE and brain magnetic resonance imaging (MRI), with subsequent intracardiac echocardiographic‐guided transcatheter PFO closure. Results: Compared to the remaining PFO population in the same period, patients with all five concomitant features had more ischemic brain lesions on MRI, previous history of recurrent stroke, more frequently a history of venous thromboembolism, and more severe migraine with aura. The concomitance of all the features confers the highest risk of recurrent stroke (OR 9.9, 3.0–18 [95% CI], P < 0.001). Conclusions: Despite its small sample size and nonrandomized retrospective nature, this is the first study to suggest that patients with concurrence of all the investigated characteristics have potentially a higher risk of stroke compared to controls. We thus propose the CARP criteria as a basis for further larger, longitudinal studies to assess the potential benefits of transcatheter closure in this patient subset in the absence of clinical recurrent stroke.
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DOI: 10.1111/j.1540-8183.2009.00478.x
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?</title><author><name sortKey="Rigatelli, Gianluca" sort="Rigatelli, Gianluca" uniqKey="Rigatelli G" first="Gianluca" last="Rigatelli">Gianluca Rigatelli</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Dell Avvocata, Fabio" sort="Dell Avvocata, Fabio" uniqKey="Dell Avvocata F" first="Fabio" last="Dell'Avvocata">Fabio Dell'Avvocata</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Giordan, Massimo" sort="Giordan, Massimo" uniqKey="Giordan M" first="Massimo" last="Giordan">Massimo Giordan</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Braggion, Gabriele" sort="Braggion, Gabriele" uniqKey="Braggion G" first="Gabriele" last="Braggion">Gabriele Braggion</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Aggio, Silvio" sort="Aggio, Silvio" uniqKey="Aggio S" first="Silvio" last="Aggio">Silvio Aggio</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Chinaglia, Mauro" sort="Chinaglia, Mauro" uniqKey="Chinaglia M" first="Mauro" last="Chinaglia">Mauro Chinaglia</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Roncon, Loris" sort="Roncon, Loris" uniqKey="Roncon L" first="Loris" last="Roncon">Loris Roncon</name><affiliation><mods:affiliation>Department of Neuroscience, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Cardaioli, Paolo" sort="Cardaioli, Paolo" uniqKey="Cardaioli P" first="Paolo" last="Cardaioli">Paolo Cardaioli</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Chen, Jack P" sort="Chen, Jack P" uniqKey="Chen J" first="Jack P." last="Chen">Jack P. Chen</name><affiliation><mods:affiliation>St. Joseph Heart and Vascular Institute, Atlanta, Georgia</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:323DB94746D6470D3D216FA1A74CAE97BA393A5E</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1111/j.1540-8183.2009.00478.x</idno><idno type="url">https://api.istex.fr/document/323DB94746D6470D3D216FA1A74CAE97BA393A5E/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001C62</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?</title><author><name sortKey="Rigatelli, Gianluca" sort="Rigatelli, Gianluca" uniqKey="Rigatelli G" first="Gianluca" last="Rigatelli">Gianluca Rigatelli</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Dell Avvocata, Fabio" sort="Dell Avvocata, Fabio" uniqKey="Dell Avvocata F" first="Fabio" last="Dell'Avvocata">Fabio Dell'Avvocata</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Giordan, Massimo" sort="Giordan, Massimo" uniqKey="Giordan M" first="Massimo" last="Giordan">Massimo Giordan</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Braggion, Gabriele" sort="Braggion, Gabriele" uniqKey="Braggion G" first="Gabriele" last="Braggion">Gabriele Braggion</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Aggio, Silvio" sort="Aggio, Silvio" uniqKey="Aggio S" first="Silvio" last="Aggio">Silvio Aggio</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Chinaglia, Mauro" sort="Chinaglia, Mauro" uniqKey="Chinaglia M" first="Mauro" last="Chinaglia">Mauro Chinaglia</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Roncon, Loris" sort="Roncon, Loris" uniqKey="Roncon L" first="Loris" last="Roncon">Loris Roncon</name><affiliation><mods:affiliation>Department of Neuroscience, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Cardaioli, Paolo" sort="Cardaioli, Paolo" uniqKey="Cardaioli P" first="Paolo" last="Cardaioli">Paolo Cardaioli</name><affiliation><mods:affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</mods:affiliation></affiliation></author><author><name sortKey="Chen, Jack P" sort="Chen, Jack P" uniqKey="Chen J" first="Jack P." last="Chen">Jack P. Chen</name><affiliation><mods:affiliation>St. Joseph Heart and Vascular Institute, Atlanta, Georgia</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Interventional Cardiology</title><idno type="ISSN">0896-4327</idno><idno type="eISSN">1540-8183</idno><imprint><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2009-08">2009-08</date><biblScope unit="volume">22</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="398">398</biblScope><biblScope unit="page" to="403">403</biblScope></imprint><idno type="ISSN">0896-4327</idno></series><idno type="istex">323DB94746D6470D3D216FA1A74CAE97BA393A5E</idno><idno type="DOI">10.1111/j.1540-8183.2009.00478.x</idno><idno type="ArticleID">JOIC478</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0896-4327</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Large patent foramen ovale (PFO), spontaneous right‐to‐left shunt, large atrial septal aneurysm (ASA), coagulation abnormalities, and prominent eustachian valve (EV) have all been independently suggested as risk factors for recurrent stroke. We sought to retrospectively evaluate risk of stroke and impact of transcatheter PFO closure in patients with concurrent large PFO, spontaneous right‐to‐left shunt, large ASA, coagulation abnormalities, and prominent EV. Methods: Between March 2006 and October 2008, 36 (mean age 44 ± 10.9 years, 28 females) out of 120 consecutive patients referred to our center for transcatheter PFO closure had concomitant diagnosis of (a) large PFO on transcranial Doppler (TCD) and transesophageal echocardiography (TEE), (b) spontaneous right‐to‐left shunt on TCD, (c) large ASA, (d) prominent EV, and (e) coagulation abnormalities. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative TEE and brain magnetic resonance imaging (MRI), with subsequent intracardiac echocardiographic‐guided transcatheter PFO closure. Results: Compared to the remaining PFO population in the same period, patients with all five concomitant features had more ischemic brain lesions on MRI, previous history of recurrent stroke, more frequently a history of venous thromboembolism, and more severe migraine with aura. The concomitance of all the features confers the highest risk of recurrent stroke (OR 9.9, 3.0–18 [95% CI], P < 0.001). Conclusions: Despite its small sample size and nonrandomized retrospective nature, this is the first study to suggest that patients with concurrence of all the investigated characteristics have potentially a higher risk of stroke compared to controls. We thus propose the CARP criteria as a basis for further larger, longitudinal studies to assess the potential benefits of transcatheter closure in this patient subset in the absence of clinical recurrent stroke.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>GIANLUCA RIGATELLI M.D.</name><affiliations><json:string>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</json:string></affiliations></json:item><json:item><name>FABIO DELL'AVVOCATA M.D.</name><affiliations><json:string>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</json:string></affiliations></json:item><json:item><name>MASSIMO GIORDAN M.D.</name><affiliations><json:string>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</json:string></affiliations></json:item><json:item><name>GABRIELE BRAGGION M.D.</name><affiliations><json:string>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</json:string></affiliations></json:item><json:item><name>SILVIO AGGIO M.D.</name><affiliations><json:string>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</json:string></affiliations></json:item><json:item><name>MAURO CHINAGLIA M.D.</name><affiliations><json:string>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</json:string></affiliations></json:item><json:item><name>LORIS RONCON M.D.</name><affiliations><json:string>Department of Neuroscience, Rovigo General Hospital, Rovigo, Italy</json:string></affiliations></json:item><json:item><name>PAOLO CARDAIOLI M.D.</name><affiliations><json:string>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</json:string></affiliations></json:item><json:item><name>JACK P. CHEN M.D.</name><affiliations><json:string>St. Joseph Heart and Vascular Institute, Atlanta, Georgia</json:string></affiliations></json:item></author><language><json:string>eng</json:string></language><abstract>Background: Large patent foramen ovale (PFO), spontaneous right‐to‐left shunt, large atrial septal aneurysm (ASA), coagulation abnormalities, and prominent eustachian valve (EV) have all been independently suggested as risk factors for recurrent stroke. We sought to retrospectively evaluate risk of stroke and impact of transcatheter PFO closure in patients with concurrent large PFO, spontaneous right‐to‐left shunt, large ASA, coagulation abnormalities, and prominent EV. Methods: Between March 2006 and October 2008, 36 (mean age 44 ± 10.9 years, 28 females) out of 120 consecutive patients referred to our center for transcatheter PFO closure had concomitant diagnosis of (a) large PFO on transcranial Doppler (TCD) and transesophageal echocardiography (TEE), (b) spontaneous right‐to‐left shunt on TCD, (c) large ASA, (d) prominent EV, and (e) coagulation abnormalities. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative TEE and brain magnetic resonance imaging (MRI), with subsequent intracardiac echocardiographic‐guided transcatheter PFO closure. Results: Compared to the remaining PFO population in the same period, patients with all five concomitant features had more ischemic brain lesions on MRI, previous history of recurrent stroke, more frequently a history of venous thromboembolism, and more severe migraine with aura. The concomitance of all the features confers the highest risk of recurrent stroke (OR 9.9, 3.0–18 [95% CI], P > 0.001). Conclusions: Despite its small sample size and nonrandomized retrospective nature, this is the first study to suggest that patients with concurrence of all the investigated characteristics have potentially a higher risk of stroke compared to controls. We thus propose the CARP criteria as a basis for further larger, longitudinal studies to assess the potential benefits of transcatheter closure in this patient subset in the absence of clinical recurrent stroke.</abstract><qualityIndicators><score>6.943</score><pdfVersion>1.4</pdfVersion><pdfPageSize>594 x 783 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>1979</abstractCharCount><pdfWordCount>3443</pdfWordCount><pdfCharCount>23172</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>281</abstractWordCount></qualityIndicators><title>Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention 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Consideration for Primary Prevention Closure?</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><availability><p>WILEY</p></availability><date>2009</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?</title><author><persName><forename type="first">GIANLUCA</forename><surname>RIGATELLI</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation></author><author><persName><forename type="first">FABIO</forename><surname>DELL'AVVOCATA</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation></author><author><persName><forename type="first">MASSIMO</forename><surname>GIORDAN</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation></author><author><persName><forename type="first">GABRIELE</forename><surname>BRAGGION</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation></author><author><persName><forename type="first">SILVIO</forename><surname>AGGIO</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation></author><author><persName><forename type="first">MAURO</forename><surname>CHINAGLIA</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation></author><author><persName><forename type="first">LORIS</forename><surname>RONCON</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Neuroscience, Rovigo General Hospital, Rovigo, Italy</affiliation></author><author><persName><forename type="first">PAOLO</forename><surname>CARDAIOLI</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation></author><author><persName><forename type="first">JACK P.</forename><surname>CHEN</surname></persName><roleName type="degree">M.D.</roleName><affiliation>St. Joseph Heart and Vascular Institute, Atlanta, Georgia</affiliation></author></analytic><monogr><title level="j">Journal of Interventional Cardiology</title><idno type="pISSN">0896-4327</idno><idno type="eISSN">1540-8183</idno><idno type="DOI">10.1111/(ISSN)1540-8183</idno><imprint><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2009-08"></date><biblScope unit="volume">22</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="398">398</biblScope><biblScope unit="page" to="403">403</biblScope></imprint></monogr><idno type="istex">323DB94746D6470D3D216FA1A74CAE97BA393A5E</idno><idno type="DOI">10.1111/j.1540-8183.2009.00478.x</idno><idno type="ArticleID">JOIC478</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background: Large patent foramen ovale (PFO), spontaneous right‐to‐left shunt, large atrial septal aneurysm (ASA), coagulation abnormalities, and prominent eustachian valve (EV) have all been independently suggested as risk factors for recurrent stroke. We sought to retrospectively evaluate risk of stroke and impact of transcatheter PFO closure in patients with concurrent large PFO, spontaneous right‐to‐left shunt, large ASA, coagulation abnormalities, and prominent EV. Methods: Between March 2006 and October 2008, 36 (mean age 44 ± 10.9 years, 28 females) out of 120 consecutive patients referred to our center for transcatheter PFO closure had concomitant diagnosis of (a) large PFO on transcranial Doppler (TCD) and transesophageal echocardiography (TEE), (b) spontaneous right‐to‐left shunt on TCD, (c) large ASA, (d) prominent EV, and (e) coagulation abnormalities. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative TEE and brain magnetic resonance imaging (MRI), with subsequent intracardiac echocardiographic‐guided transcatheter PFO closure. Results: Compared to the remaining PFO population in the same period, patients with all five concomitant features had more ischemic brain lesions on MRI, previous history of recurrent stroke, more frequently a history of venous thromboembolism, and more severe migraine with aura. The concomitance of all the features confers the highest risk of recurrent stroke (OR 9.9, 3.0–18 [95% CI], P < 0.001). Conclusions: Despite its small sample size and nonrandomized retrospective nature, this is the first study to suggest that patients with concurrence of all the investigated characteristics have potentially a higher risk of stroke compared to controls. We thus propose the CARP criteria as a basis for further larger, longitudinal studies to assess the potential benefits of transcatheter closure in this patient subset in the absence of clinical recurrent stroke.</p></abstract></profileDesc><revisionDesc><change when="2009-08">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/323DB94746D6470D3D216FA1A74CAE97BA393A5E/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Inc</publisherName><publisherLoc>Malden, USA</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1540-8183</doi><issn type="print">0896-4327</issn><issn type="electronic">1540-8183</issn><idGroup><id type="product" value="JOIC"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="JOURNAL OF INTERVENTIONAL CARDIOLOGY">Journal of Interventional Cardiology</title></titleGroup></publicationMeta><publicationMeta level="part" position="08004"><doi origin="wiley">10.1111/joic.2009.22.issue-4</doi><numberingGroup><numbering type="journalVolume" number="22">22</numbering><numbering type="journalIssue" number="4">4</numbering></numberingGroup><coverDate startDate="2009-08">August 2009</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="13" status="forIssue"><doi origin="wiley">10.1111/j.1540-8183.2009.00478.x</doi><idGroup><id type="unit" value="JOIC478"></id></idGroup><countGroup><count type="pageTotal" number="6"></count></countGroup><titleGroup><title type="tocHeading1">STRUCTURAL HEART DISEASE</title></titleGroup><copyright>©2009, the Authors Journal compilation ©2009, Wiley Periodicals, Inc.</copyright><eventGroup><event type="firstOnline" date="2009-06-08"></event><event type="publishedOnlineFinalForm" date="2009-08-02"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.5 mode:FullText source:FullText result:FullText" date="2010-04-07"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-31"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-30"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="398">398</numbering><numbering type="pageLast" number="403">403</numbering></numberingGroup><correspondenceTo>Address for reprints: Gianluca Rigatelli, M.D., F.A.C.P., F.A.C.C., F.E.S.C., F.S.C.A.I., Section of Adult Congenital Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy, Via WA Mozart, 9, 37040 Legnago, Verona, Italy. Fax: +39044220164; e‐mail: <email>jackyheart@libero.it</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:JOIC.JOIC478.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="2"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="32"></count><count type="linksCrossRef" number="42"></count></countGroup><titleGroup><title type="main">Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?</title><title type="shortAuthors">RIGATELLI, ET AL.</title><title type="short">DEFINING A PFO HIGH‐RISK POPULATION</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>GIANLUCA</givenNames><familyName>RIGATELLI</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>FABIO</givenNames><familyName>DELL'AVVOCATA</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>MASSIMO</givenNames><familyName>GIORDAN</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1"><personName><givenNames>GABRIELE</givenNames><familyName>BRAGGION</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a1"><personName><givenNames>SILVIO</givenNames><familyName>AGGIO</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a1"><personName><givenNames>MAURO</givenNames><familyName>CHINAGLIA</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a2"><personName><givenNames>LORIS</givenNames><familyName>RONCON</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr8" affiliationRef="#a1"><personName><givenNames>PAOLO</givenNames><familyName>CARDAIOLI</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr9" affiliationRef="#a3"><personName><givenNames>JACK P.</givenNames><familyName>CHEN</familyName><degrees>M.D.</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="IT"><unparsedAffiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="IT"><unparsedAffiliation>Department of Neuroscience, Rovigo General Hospital, Rovigo, Italy</unparsedAffiliation></affiliation><affiliation xml:id="a3" countryCode="US"><unparsedAffiliation>St. Joseph Heart and Vascular Institute, Atlanta, Georgia</unparsedAffiliation></affiliation></affiliationGroup><abstractGroup><abstract type="main" xml:lang="en"><p> <i><b>Background:</b> Large patent foramen ovale (PFO), spontaneous right‐to‐left shunt, large atrial septal aneurysm (ASA), coagulation abnormalities, and prominent eustachian valve (EV) have all been independently suggested as risk factors for recurrent stroke. We sought to retrospectively evaluate risk of stroke and impact of transcatheter PFO closure in patients with concurrent large PFO, spontaneous right‐to‐left shunt, large ASA, coagulation abnormalities, and prominent EV.</i> </p><p> <i><b>Methods:</b> Between March 2006 and October 2008, 36 (mean age 44 ± 10.9 years, 28 females) out of 120 consecutive patients referred to our center for transcatheter PFO closure had concomitant diagnosis of (a) large PFO on transcranial Doppler (TCD) and transesophageal echocardiography (TEE), (b) spontaneous right‐to‐left shunt on TCD, (c) large ASA, (d) prominent EV, and (e) coagulation abnormalities. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative TEE and brain magnetic resonance imaging (MRI), with subsequent intracardiac echocardiographic‐guided transcatheter PFO closure.</i> </p><p> <i><b>Results:</b> Compared to the remaining PFO population in the same period, patients with all five concomitant features had more ischemic brain lesions on MRI, previous history of recurrent stroke, more frequently a history of venous thromboembolism, and more severe migraine with aura. The concomitance of all the features confers the highest risk of recurrent stroke (OR 9.9, 3.0–18 [95% CI], P < 0.001).</i> </p><p> <i><b>Conclusions:</b> Despite its small sample size and nonrandomized retrospective nature, this is the first study to suggest that patients with concurrence of all the investigated characteristics have potentially a higher risk of stroke compared to controls. We thus propose the CARP criteria as a basis for further larger, longitudinal studies to assess the potential benefits of transcatheter closure in this patient subset in the absence of clinical recurrent stroke.</i> </p><!-- (J Interven Cardiol 2009;22:398–403)
</abstractGroup></contentMeta><noteGroup><note xml:id="n-fnt-1" numbered="no"><p>Disclosures: None of the authors has relevant conflict of interest with the subject or the data matter of the research.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?</title></titleInfo><titleInfo type="abbreviated"><title>DEFINING A PFO HIGH‐RISK POPULATION</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?</title></titleInfo><name type="personal"><namePart type="given">GIANLUCA</namePart><namePart type="family">RIGATELLI</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">FABIO</namePart><namePart type="family">DELL'AVVOCATA</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">MASSIMO</namePart><namePart type="family">GIORDAN</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">GABRIELE</namePart><namePart type="family">BRAGGION</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">SILVIO</namePart><namePart type="family">AGGIO</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">MAURO</namePart><namePart type="family">CHINAGLIA</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">LORIS</namePart><namePart type="family">RONCON</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Neuroscience, Rovigo General Hospital, Rovigo, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">PAOLO</namePart><namePart type="family">CARDAIOLI</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">JACK P.</namePart><namePart type="family">CHEN</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>St. Joseph Heart and Vascular Institute, Atlanta, Georgia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article">article</genre><originInfo><publisher>Blackwell Publishing Inc</publisher><place><placeTerm type="text">Malden, USA</placeTerm></place><dateIssued encoding="w3cdtf">2009-08</dateIssued><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">2</extent><extent unit="references">32</extent></physicalDescription><abstract lang="en">Background: Large patent foramen ovale (PFO), spontaneous right‐to‐left shunt, large atrial septal aneurysm (ASA), coagulation abnormalities, and prominent eustachian valve (EV) have all been independently suggested as risk factors for recurrent stroke. We sought to retrospectively evaluate risk of stroke and impact of transcatheter PFO closure in patients with concurrent large PFO, spontaneous right‐to‐left shunt, large ASA, coagulation abnormalities, and prominent EV. Methods: Between March 2006 and October 2008, 36 (mean age 44 ± 10.9 years, 28 females) out of 120 consecutive patients referred to our center for transcatheter PFO closure had concomitant diagnosis of (a) large PFO on transcranial Doppler (TCD) and transesophageal echocardiography (TEE), (b) spontaneous right‐to‐left shunt on TCD, (c) large ASA, (d) prominent EV, and (e) coagulation abnormalities. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative TEE and brain magnetic resonance imaging (MRI), with subsequent intracardiac echocardiographic‐guided transcatheter PFO closure. Results: Compared to the remaining PFO population in the same period, patients with all five concomitant features had more ischemic brain lesions on MRI, previous history of recurrent stroke, more frequently a history of venous thromboembolism, and more severe migraine with aura. The concomitance of all the features confers the highest risk of recurrent stroke (OR 9.9, 3.0–18 [95% CI], P < 0.001). Conclusions: Despite its small sample size and nonrandomized retrospective nature, this is the first study to suggest that patients with concurrence of all the investigated characteristics have potentially a higher risk of stroke compared to controls. We thus propose the CARP criteria as a basis for further larger, longitudinal studies to assess the potential benefits of transcatheter closure in this patient subset in the absence of clinical recurrent stroke.</abstract><relatedItem type="host"><titleInfo><title>Journal of Interventional Cardiology</title></titleInfo><identifier type="ISSN">0896-4327</identifier><identifier type="eISSN">1540-8183</identifier><identifier type="DOI">10.1111/(ISSN)1540-8183</identifier><identifier type="PublisherID">JOIC</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>22</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>398</start><end>403</end><total>6</total></extent></part></relatedItem><identifier type="istex">323DB94746D6470D3D216FA1A74CAE97BA393A5E</identifier><identifier type="DOI">10.1111/j.1540-8183.2009.00478.x</identifier><identifier type="ArticleID">JOIC478</identifier><accessCondition type="use and reproduction" contentType="copyright">©2009, the Authors Journal compilation ©2009, Wiley Periodicals, Inc.</accessCondition><recordInfo><recordOrigin>Blackwell Publishing Inc</recordOrigin><recordContentSource>WILEY</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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