AI Article Synopsis
- Patients with acute pulmonary embolism (PE) and a patent foramen ovale (PFO) are at a significantly increased risk of ischemic stroke compared to those without a PFO, with stroke rates of 19.5% versus 4.5%, respectively.
- A systematic review and meta-analysis of 8 studies involving 1,197 patients highlighted this risk, showing a strong association between PFO and stroke in the context of PE (odds ratio of 5.36).
- The findings also suggest that patients with PFO may experience higher mortality rates during acute PE episodes, indicating a need for careful monitoring and treatment strategies for this group.
Article Abstract
Objective: Patients with acute pulmonary hypertension during an acute pulmonary embolism (PE) can develop stroke due to paradoxical embolism in the presence of a patent foramen ovale (PFO). We evaluated the current evidence regarding the risk of ischemic stroke and mortality in patients with PE and a PFO.
Methods: We performed a systematic review and meta-analysis of studies found on PubMed, the Cochrane Library, Embase, SCOPUS, and the BVS portal. We included full-length reports, prospective observational cohorts, and clinical trials of adult patients (aged ≥18 years) diagnosed with PE and investigating the presence of PFO and new ischemic brain injuries. This study is registered with PROSPERO (CRD42023467133).
Results: The initial search identified 1398 articles. After applying exclusion criteria, only 8 articles remained, including a total of 1197 individuals with PE, among whom PFO was identified in 318 patients. Ischemic stroke occurred in 62/318 (19.5 %) individuals in the PFO group and in 40/879 (4.5 %) individuals in the non-PFO group. The prevalence of ischemic stroke in the PFO group was higher than in the non-PFO group in all eight studies. The meta-analysis showed that PFO was significantly associated with ischemic stroke in patients with PE compared to those without PFO (odds ratio 5.36, 95 % CI 3.20-8.99, p < 0.00001; I² = 0 %). Three studies also reported higher mortality in the PFO group.
Conclusion: Patent foramen ovale is a common condition in patients with acute PE and is associated with a higher incidence of ischemic stroke and increased mortality.
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| http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2024.108157 | DOI Listing |
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