Presence of dual cardiac defects tied to increased recurrent stroke risk


NEW YORK (Reuters Health) – Patients with a patent foramen ovale and an atrial septal aneurysm are much more likely to experience a recurrent stroke than patients with one or none of these defects, according to a report published in the December 13th issue of The New England Journal of Medicine.

Dr. Jean-Louis Mas, from Sainte-Anne Hospital in Paris, and colleagues assessed the outcomes of 581 patients who had an ischemic stroke of unknown origin in the 3 months prior to study entry.

Echocardiography was performed at initial presentation to determine the presence of a patent foramen ovale and/or an atrial septal aneurysm. The patients were followed for 4 years and all received 300 mg/day of aspirin for secondary prevention.

Patients with both cardiac defects were 4.17 times more likely to experience a recurrent stroke than patients with no defects. The risks of recurrent stroke among patients with both defects, only a patent foramen ovale, and no defects were 15.2%, 2.3%, and 4.2%, respectively. None of the patients with an isolated atrial septal aneurysm experienced a recurrent stroke.

The mechanism for the increased risk may involve abnormal motion of the fossa ovalis membrane, the authors speculate. This motion could enhance blood flow from the inferior vena cava toward the foramen ovale. Another possibility is that the presence of both defects increases the likelihood of more severe atrial septal diseases being present.

The current findings suggest that aspirin is inadequate as the sole stroke prevention measure in patients with both cardiac defects, the investigators add. Further studies are needed to determine the optimal therapeutic strategy for such patients.

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