Difference in infarct pattern and clinical status between patent foramen ovale and atrial fibrillation

초록

Background and Purpose: Atrial fibrillation (AF) and patent foramen ovale (PFO) are established sources of cardioembolism. Compared to cardioembolic infarction related to AF, infarct prognosis and pattern of PFO remain unclear. We investigated differences in stroke prognosis and patterns between PFO and AF. Methods: We performed a retrospective review of the medical records and brain MR image of patients with AF or PFO from the prospective acute stroke and transient ischemic attack (TIA) registry. Infarct patterns on MR were classified on basis of diffusion weighted images. Infarct volume, symptomatic stenosis or occlusion (SSO) of the relevant artery, and existence of PFO were assessed in all patients. Territorial infarction without SSO or multiple vascular territorial infarction was regarded as probable systemic embolism (PSE) pattern. Results: From June 2004 to July 2008, a total of 289 subjects were identified among 1559 acute stroke patients (AF group, n=156; PFO group, n=133). Analysis of MR images revealed more PSE pattern in AF compared to PFO (71.8 vs. 41.4%, p<0.01). The patients with PFO had the smaller infarct than those with AF (5.7±8.7 vs. 51.9±85.1 ml, P<0.01). Compared to AF, the existence of PFO was the independent predictor for the better clinical status (NIHSS≤3) after adjusting old age, sex, and previous stroke history. Conclusions: Compared to AF, cerebral infarction related to PFO might be smaller and lead to better prognosis. These results suggested that different sources of cardioembolism would result in different infarct patterns as well as different stroke risk.