Difference in Infarct Volume and Initial Clinical Severity between Stroke Patient with Patent Foramen Ovale and Atrial Fibrillation

Hong, Chang Gi; Kim, Il Gon; Lee, Jeong; Choi, Yoonjae; Ryoo, Na Young; Rha, Joung Ho; Park, Hee Kwon

Abstract

BACKGROUND
Atrial fibrillation (AF) and patent foramen ovale (PFO) are established sources of cardioembolism. We investigated differences in stroke outcome and patterns between PFO and AF.
METHODS
We performed a retrospective review of the medical records and brain MR images of patients with AF or PFO from the prospective acute stroke and transient ischemic attack registry. Infarct pattern and volume on diffusion-weighted imaging, and the national institutes of health stroke scale (NIHSS) on admission were compared between patients with AF and PFO.
RESULTS
From June 2005 to July 2008, a total of 289 subjects were enrolled (AF group, n=156; PFO group, n=133). Infarct pattern analyzed with MR images revealed that multiple vascular territorial infarction was more prevalent in AF group than in PFO group (26.9% vs. 8.3%, P<0.01). A probable cardiac embolism, radiologically defined as territorial infarction without symptomatic steno-occlusion of the corresponding artery, was more frequently documented in AF group than in PFO group (71.8% vs. 41.4%, P<0.01) The infarct volume of PFO was smaller than that of AF. Compared to AF, PFO was associated with the mild neurologic deficit (NIHSS< or =3) after adjusting age, sex and previous stroke history.
CONCLUSION
These results suggested that AF and PFO had different characteristics such as infarct patterns and initial clinical severity although both are classified as cardioembolism.