Comparative analysis of echocardiographic and clinical characteristics
among patients afflicted by embolic stroke of undetermined source and
migraine, both accompanied by patent foramen ovale
Abstract
Background: This study aimed to compare patients with migraine
and embolic stroke of undetermined source (ESUS) with known patent
foramen ovale (PFO) in terms of echocardiographic and clinical features.
Methods: In this observational single-center study, we obtained
2-dimensional (2D) and color Doppler images using parasternal short axis
(PSAX), apical 4-chamber (A4C), and subcostal 4-chamber (SC4C)
transthoracic echocardiography (TTE) views for patients with Migraine
and ESUS. In cases where a PFO was suspected, patients underwent
transthoracic contrast echocardiography and transesophageal
echocardiography (TEE). We compared the anatomical and functional
high-risk characteristics of PFO, as assessed by TEE and the RoPe score,
in both patient groups. Results: This research involved a
cohort of 720 individuals with ages ranging from 18 to 60, and 73.2% of
the participants were female. Among the participants, 43.5% had
Migraine, and 56.5% had ESUS. The most common comorbidity was diabetes
(26.1%). PFO characteristics were measured, and high-velocity shunting
through the interatrial septum was observed in 35.5% of patients. ESUS
patients had a higher median age, with a similar gender distribution.
ESUS patients had higher rates of diabetes and hypertension, while
active smoking was more common in Migraine patients. Basic
echocardiographic parameters were similar, except for higher pulmonary
artery systolic pressure in ESUS. In the ESUS group, as compared to the
migraine group, there was a more substantial occurrence of large
microbubble passage through the interatrial septum, and the PFO showed
increased length, while the PFO width remained similar. The RoPe and
High-risk PFO scores were similar between the groups.
Conclusions: ESUS patients were older with higher rates of
diabetes and hypertension, while Migraine patients had a higher
prevalence of active smoking. ESUS patients showed elevated pulmonary
artery pressure, increased large microbubble crossings through the
interatrial septum, and longer PFO lengths.