• Sylwia Goliszek, Małgorzata Wiśniewska, Katarzyna Kurnicka, Barbara Lichodziejewska, Michał Ciurzyński, Maciej Kostrubiec, Marek Gołębiowski, Marek Babiuch, Marzanna Paczynska, Marcin Koć, Piotr Palczewski, Anna Wyzgał, and Piotr Pruszczyk.
• Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
• Thromb. Res. 2014 Nov 1;134(5):1052-6.

BackgroundPatent foramen ovale (PFO) is an established risk factor for ischemic stroke. Since acute right ventricular dysfunction (RVD) observed in patients with PE can lead to right-to-left inter-atrial shunt via PFO, we hypothesized that PFO is a risk factor for ischemic stroke in PE with significant right ventricular dysfunction.Methods55 patients (31 F, 24M), median age 49 years (range 19-83 years) with confirmed PE underwent echocardiography for RVD and PFO assessment. High risk acute PE was diagnosed in 3 (5.5%) patients, while 16 (29%) hemodynamically stable with RVD patients formed a group with intermediate-risk PE. PFO was diagnosed in 19 patients (34.5%). Diffusion-weighted MRI of the brain for acute ischemic stroke (AIS) was performed in all patients 4.91 ± 4.1 days after admission.ResultsAIS was detected by MRI in 4 patients (7.3%). Only one stroke was clinically overt and resulted in hemiplegia. All 4 AIS occurred in the PFO positive group (4 of 19 patients), and none in subjects without PFO (21.0% vs 0%, p=0.02). Moreover, all AIS occurred in patients with RVD and PFO, and none in patients with PFO without RVD (50% vs 0%, p=0.038).ConclusionOur data suggest that acute pulmonary embolism resulting in right ventricular dysfunction may lead to acute ischemic stroke in patients with patent foramen ovale. However, the clinical significance of such lesions remains to be determined.Copyright © 2014 Elsevier Ltd. All rights reserved.

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