J Stroke.  2023 Sep;25(3):417-420. 10.5853/jos.2023.01179.

Patent Foramen Ovale May Decrease the Risk of Left Atrial Thrombosis in Stroke Patients With Atrial Fibrillation

• Baik M
• Shim CY
• Gwak SY
• Kim YD
• Nam HS
• Jeon S
• Lee HS
• Heo JH

• KMID: 2546444
• DOI: http://doi.org/10.5853/jos.2023.01179

Figure

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  Figure 1. Mediation of effects of PFO on LA/LAA thrombus or SEC. Pathway of mediation analysis showing how echocardiographic parameters mediate the effect of PFO on LA/LAA thrombus or SEC. (A) The direct effect of PFO on LA/LAA thrombus or SEC and (B) LAAV mediation of the effect of PFO on LA/LAA thrombus or SEC. Comparable coefficients: a, the effect of PFO on LAAV; b, effect of LAAV on LA/LAA thrombus or SEC; c, direct association between PFO and LA/LAA thrombus or SEC (without adjusting for LAAV); and c’, association between PFO and LA/LAA thrombus or SEC adjusting for LAAV. The degree of mediation is shown as Baron and Kenny’s proportion of effect mediation (%). PFO, patent foramen ovale; LA, left atrial; LAA, left atrial appendage; SEC, spontaneous echo contrast; LAAV, left atrial appendage emptying velocity. *P<0.05.

Reference

References

1. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994; 23:961–969.

2. Mügge A, Kühn H, Nikutta P, Grote J, Lopez JA, Daniel WG. Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk. J Am Coll Cardiol. 1994; 23:599–607.

3. Elgendy AY, Saver JL, Amin Z, Boudoulas KD, Carroll JD, Elgendy IY, et al. Proposal for updated nomenclature and classification of potential causative mechanism in patent foramen ovale–associated stroke. JAMA Neurol. 2020; 77:878–886.

4. Baik M, Shim CY, Gwak SY, Kim YD, Nam HS, Lee HS, et al. Patent foramen ovale and risk of recurrence in stroke of determined etiology. Ann Neurol. 2022; 92:596–606.

5. Bang OY, Park KM, Jeong DS. Occurrence of ischemic stroke in patients with atrial fibrillation receiving non-vitamin K oral anticoagulants: causes and prevention strategies. J Stroke. 2023; 25:199–213.

6. Heo J, Lee H, Lee IH, Nam HS, Kim YD. Impact of left atrial or left atrial appendage thrombus on stroke outcome: a matched control analysis. J Stroke. 2023; 25:111–118.

7. Vandenberk B, Morillo CA. Atrial fibrillation after transcatheter patent foramen ovale closure: to measure is to know. Heart Rhythm. 2022; 19:1421–1422.

8. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51:1173–1182.

9. Babur Guler G, Dogan AC, Kalkan AK, Demir AR, Uygur B, Birant A, et al. Does patent foramen ovale presence procure favourable outcomes in patients with severe rheumatic mitral stenosis? Int J Cardiovasc Imaging. 2021; 37:2871–2879.

10. Kawano H, Honda Y, Johno T, Maruoka H, Nakanishi K, Saito M, et al. Antiplatelet therapy may be insufficient to prevent stroke recurrence before percutaneous patent foramen ovale closure. J Stroke. 2023; 25:307–310.