Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?
Identifieur interne : 000D32 ( Main/Merge ); précédent : 000D31; suivant : 000D33Embolic Implications of Combined Risk Factors in Patients with Patent Foramen Ovale (the CARPE Criteria): Consideration for Primary Prevention Closure?
Auteurs : Gianluca Rigatelli [Italie] ; Fabio Dell'Avvocata [Italie] ; Massimo Giordan [Italie] ; Gabriele Braggion [Italie] ; Silvio Aggio [Italie] ; Mauro Chinaglia [Italie] ; Loris Roncon [Italie] ; Paolo Cardaioli [Italie] ; Jack P. Chen [Géorgie (pays)]Source :
- 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></author><author><name sortKey="Dell Avvocata, Fabio" sort="Dell Avvocata, Fabio" uniqKey="Dell Avvocata F" first="Fabio" last="Dell'Avvocata">Fabio Dell'Avvocata</name></author><author><name sortKey="Giordan, Massimo" sort="Giordan, Massimo" uniqKey="Giordan M" first="Massimo" last="Giordan">Massimo Giordan</name></author><author><name sortKey="Braggion, Gabriele" sort="Braggion, Gabriele" uniqKey="Braggion G" first="Gabriele" last="Braggion">Gabriele Braggion</name></author><author><name sortKey="Aggio, Silvio" sort="Aggio, Silvio" uniqKey="Aggio S" first="Silvio" last="Aggio">Silvio Aggio</name></author><author><name sortKey="Chinaglia, Mauro" sort="Chinaglia, Mauro" uniqKey="Chinaglia M" first="Mauro" last="Chinaglia">Mauro Chinaglia</name></author><author><name sortKey="Roncon, Loris" sort="Roncon, Loris" uniqKey="Roncon L" first="Loris" last="Roncon">Loris Roncon</name></author><author><name sortKey="Cardaioli, Paolo" sort="Cardaioli, Paolo" uniqKey="Cardaioli P" first="Paolo" last="Cardaioli">Paolo Cardaioli</name></author><author><name sortKey="Chen, Jack P" sort="Chen, Jack P" uniqKey="Chen J" first="Jack P." last="Chen">Jack P. Chen</name></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><idno type="wicri:Area/Istex/Curation">001850</idno><idno type="wicri:Area/Istex/Checkpoint">000793</idno><idno type="wicri:doubleKey">0896-4327:2009:Rigatelli G:embolic:implications:of</idno><idno type="wicri:Area/Main/Merge">000D32</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 wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo</wicri:regionArea><wicri:noRegion>Rovigo</wicri:noRegion></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 wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo</wicri:regionArea><wicri:noRegion>Rovigo</wicri:noRegion></affiliation></author><author><name sortKey="Giordan, Massimo" sort="Giordan, Massimo" uniqKey="Giordan M" first="Massimo" last="Giordan">Massimo Giordan</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo</wicri:regionArea><wicri:noRegion>Rovigo</wicri:noRegion></affiliation></author><author><name sortKey="Braggion, Gabriele" sort="Braggion, Gabriele" uniqKey="Braggion G" first="Gabriele" last="Braggion">Gabriele Braggion</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo</wicri:regionArea><wicri:noRegion>Rovigo</wicri:noRegion></affiliation></author><author><name sortKey="Aggio, Silvio" sort="Aggio, Silvio" uniqKey="Aggio S" first="Silvio" last="Aggio">Silvio Aggio</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo</wicri:regionArea><wicri:noRegion>Rovigo</wicri:noRegion></affiliation></author><author><name sortKey="Chinaglia, Mauro" sort="Chinaglia, Mauro" uniqKey="Chinaglia M" first="Mauro" last="Chinaglia">Mauro Chinaglia</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo</wicri:regionArea><wicri:noRegion>Rovigo</wicri:noRegion></affiliation></author><author><name sortKey="Roncon, Loris" sort="Roncon, Loris" uniqKey="Roncon L" first="Loris" last="Roncon">Loris Roncon</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neuroscience, Rovigo General Hospital, Rovigo</wicri:regionArea><wicri:noRegion>Rovigo</wicri:noRegion></affiliation></author><author><name sortKey="Cardaioli, Paolo" sort="Cardaioli, Paolo" uniqKey="Cardaioli P" first="Paolo" last="Cardaioli">Paolo Cardaioli</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo</wicri:regionArea><wicri:noRegion>Rovigo</wicri:noRegion></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 wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>St. Joseph Heart and Vascular Institute, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></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></record>Pour manipuler ce document sous Unix (Dilib)
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