Koutroulou Ioanna, Tsivgoulis Georgios, Karacostas Dimitris, Ikonomidis Ignatios, Grigoriadis Nikolaos, Karapanayiotides Theodoros
2nd Department of Neurology, AHEPA University Hospital, School of Health Sciences, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Ther Adv Neurol Disord. 2020 Oct 10;13:1756286420964673. doi: 10.1177/1756286420964673. eCollection 2020.
The risk of paradoxical embolism (RoPE) score calculates the probability that patent foramen ovale (PFO) is causally related to stroke (PFO attributable fraction, PFOAF), based on PFO prevalence in patients with cryptogenic stroke (CS) compared with that in the general population. The latter has been estimated at 25%; however, PFO prevalence in nonselected populations varies widely.
Since PFO prevalence in Greece remains unknown, we evaluated it and we calculated PFOAF stratified by RoPE score in a cohort of patients with CS ⩽55 years old. PFO was detected according to the international consensus transcranial Doppler (TCD) criteria in 124 healthy subjects (H), in 102 patients with CS, and in 56 patients with stroke of known cause (nonCS). Each subject underwent unilateral middle cerebral artery recording after infusion of agitated saline, at rest, and after a controlled Valsalva maneuver. We characterized PFO as large (>20 microbubbles or curtain), moderate (11-20), and small (⩽10).
PFO was detected in 42.7% of H, 49% of CS, and 25% of nonCS ( = 0.013). Large PFOs were numerically higher in CS [28.4% (29/102)] compared with H [19.3% (24/124); = 0.1] and to nonCS [7.1% (4/56), = 0.04]. The median RoPE score in patients with CS and PFO was seven. Even patients with very high RoPE score (9-10) had moderate PFOAF (57%). For any individual stratum up to RopE score 8, PFOAF was <33%.
PFO prevalence in the Greek population is much higher than the widely accepted 25%. PFO may be the cause of stroke in one out of nine Greek patients with CS. Among Greek CS patients who harbor a PFO, the latter is causal in one out of five. The established RoPE score cutoff of ⩾7 for having a probable PFO-associated stroke may overestimate the probability in patients deriving from populations with high PFO prevalence.
反常栓塞风险（RoPE）评分基于不明原因卒中（CS）患者与普通人群相比的卵圆孔未闭（PFO）患病率，计算PFO与卒中存在因果关系的概率（PFO归因分数，PFOAF）。普通人群中的PFO患病率估计为25%；然而，未经过选择的人群中PFO患病率差异很大。
由于希腊的PFO患病率尚不清楚，我们对55岁及以下的CS患者队列进行了评估，并按RoPE评分分层计算PFOAF。根据国际共识经颅多普勒（TCD）标准，在124名健康受试者（H）、102名CS患者和56名已知病因卒中患者（非CS）中检测PFO。每位受试者在静息状态下、输注振荡生理盐水后以及进行控制性瓦尔萨尔瓦动作后，进行单侧大脑中动脉记录。我们将PFO分为大（>20个微泡或呈帷幕状）、中（11 - 20个）和小（≤10个）。
在42.7%的H、49%的CS和25%的非CS中检测到PFO（P = 0.013）。与H [19.3%（24/124）；P = 0.1]和非CS [7.1%（4/56），P = 0.04]相比，CS中大型PFO在数量上更高[28.4%（29/102）]。CS合并PFO患者的RoPE评分中位数为7。即使是RoPE评分非常高（9 - 10）的患者，PFOAF也为中等（57%）。对于RopE评分8及以下的任何个体分层，PFOAF均<33%。
希腊人群中的PFO患病率远高于广泛认可的25%。在希腊每9名CS患者中，可能有1例由PFO导致卒中。在希腊患有PFO的CS患者中，每5例中有1例是由PFO引起的。既定的RoPE评分≥7作为可能与PFO相关卒中的临界值，可能会高估来自PFO患病率高的人群中患者的概率。
