Aortic root dilatation in PFO‐related cryptogenic stroke: A propensity score–matched analysis

• Published in: Echocardiography Vol. 37; no. 6; pp. 883 - 890
• Main Authors: Beyls, Christophe, Bohbot, Yohann, Marion, Bourgain, Canaple, Sandrine, Guillaumont, Marie‐Pierre, Jarry, Geneviève, Fournier, Alexandre, Malaquin, Dorothée, Abou‐Arab, Osama, Mahjoub, Yazine, Tribouilloy, Christophe, Leborgne, Laurent
• Format: Journal Article
• Language: English
• Published: United States Wiley 01.06.2020
• Subjects: [SDV]Life Sciences [q-bio]; aortic root dilatation; cryptogenic stroke; Dilatation; echocardiography; Foramen Ovale, Patent; Humans; Ischemic Stroke; Life Sciences; patent foramen ovale; patent foramen ovale closure; Propensity Score; Retrospective Studies; Risk Factors; Stroke; patent foramen ovale closure; patent foramen ovale; cryptogenic stroke; aortic root dilatation; echocardiography
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/echo.14711

Background Dilatation of the ascending aorta has an important role in the anatomical conformation of interatrial septum (IAS) especially when a patent foramen ovale (PFO) is present. The aim of the study was to investigate the relationship between ascending aortic dilation and PFO‐related cryptogenic stroke in a cohort of cryptogenic strokes. Methods It is a retrospective, single‐center echocardiographic study assessing aortic root dilatation in 315 consecutive patients with cryptogenic stroke between January 2011 and January 2019. Aortic root dilatation was defined by a diameter of the Valsalva sinuses of the proximal aorta >40 mm. Predictive factors of PFO were assessed by a multivariate analysis. Propensity score matching was applied to account for clinical differences. Results Of the 315 patients, 68 (22%) had an aortic root dilatation and 167 (53%) had a PFO. In the aortic root dilation group, PFO was more often diagnosed (n = 47/68 [69%], vs n = 120/247 [49%], P = .004). In the PFO group with aortic dilatation, IAS was more mobile (n = 37/47[79%] vs n = 69/120[57%], P < .012) and smaller (2.3 ± 0.5 vs 2.5 ± 0.5 mm, P < .009). On multivariate analysis, aortic root dilatation (OR: 2.6; 95% CI [1.2–5.6]; P = .001) and IAS hypermobility (OR: 5.2 95% CI [2.7–10]; P = .001) were associated with PFO. After propensity matching, aortic root dilatation remained strongly associated with PFO (n = 34/107 [32%] vs 15/107[14%], P = .002). Conclusion Aortic root dilation and IAS hypermobility were strongly associated with PFO‐related cryptogenic stroke.