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West BH, Fleming RG, Al Hemyari B, Banankhah P, Meyer K, Rozier LH, Murphy LS, Coluzzi AC, Rusheen JL, Kumar P, Elashoff D, Tobis JM. Relation of Patent Foramen Ovale to Acute Mountain Sickness. Am J Cardiol 2019; 123:2022-2025. [PMID: 30979412 DOI: 10.1016/j.amjcard.2019.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 01/28/2023]
Abstract
Over 50% of patients who rapidly ascend to extreme altitudes develop various symptoms known as acute mountain sickness (AMS), which rarely can be life threatening. It is unclear why some patients are more susceptible to AMS than others. Our objective was to determine whether patent foramen ovale (PFO) is a risk factor for AMS. Subjects who had hiked to altitudes above 10,000' (∼3,000 meters) on the John Muir Trail in California were recruited. Participants completed a questionnaire and 2-physician adjudication was performed in regard to AMS status. A transcranial Doppler with agitated saline contrast injection was performed to evaluate the presence or absence of PFO. The primary outcome was the development of AMS. From 2016 to 2018, 137 hikers were recruited into the study. There was a higher prevalence of PFO in hikers with AMS 15 of 24 (63%) compared with hikers without AMS 44 of 113 (39%); p = 0.034. In the multivariate model, the presence of a PFO significantly increased the risk for developing AMS: odds ratio 4.15, 95% confidence intervals 1.14 to 15.05; p = 0.030. In conclusion, hikers with a PFO had significantly higher risk of developing AMS relative to hikers without a PFO. Clinicians should consider PFO a risk factor in patients who plan to hike to high altitudes.
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West BH, Noureddin N, Mamzhi Y, Low CG, Coluzzi AC, Shih EJ, Gevorgyan Fleming R, Saver JL, Liebeskind DS, Charles A, Tobis JM. Frequency of Patent Foramen Ovale and Migraine in Patients With Cryptogenic Stroke. Stroke 2018; 49:1123-1128. [PMID: 29636424 DOI: 10.1161/strokeaha.117.020160] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Individuals with migraine are at higher risk for stroke, but the mechanism has not been established. On the basis of the association between migraine and intracardiac right-to-left shunt, it has been proposed that stroke in migraineurs could be caused by a paradoxical embolus passing through a patent foramen ovale (PFO) or pulmonary arteriovenous malformation. The aim of this study was to determine the prevalence of PFO with right-to-left shunt in patients who presented with cryptogenic stroke and had a history of migraine. METHODS Patients between 18 and 60 years old who presented with an ischemic stroke were characterized based on ASCOD phenotyping (atherosclerosis; small-vessel disease; cardiac pathology; other causes; dissection). A migraine diagnosis was identified by reviewing physician notes, and frequent aura was defined if present in at least 50% of attacks. A PFO with right-to-left shunt diagnosis was identified by the presence of a positive bubble contrast study with either transcranial Doppler, transthoracic, or transesophageal echocardiography. RESULTS Of the 712 patients who presented with ischemic stroke, 127 (18%) were diagnosed as cryptogenic; 68 patients had adequate testing for PFO and a documented migraine history. The prevalence of PFO in patients with cryptogenic stroke without migraine was elevated (59%) compared with the general population (18%). Patients with both cryptogenic stroke and migraine had a higher prevalence of PFO (79%). In patients with cryptogenic stroke who had migraine with frequent aura, the prevalence of PFO was 93%. Only 5 patients (4%) had a history compatible with migrainous infarction. CONCLUSIONS In patients with cryptogenic stroke who have migraine, there is a high prevalence (79%) of PFO with right-to-left shunt. The timing of the stroke in migraineurs is usually not related to a migraine attack. These observations are consistent with the hypothesis that the mechanism of stroke in migraineurs is most likely because of a paradoxical embolus. Future cryptogenic stroke classification schemes should consider including PFO as a separate etiologic category.
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Affiliation(s)
- Brian H West
- From the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.)
| | - Nabil Noureddin
- Department of Internal Medicine, UNLV School of Medicine, Las Vegas, NV (N.N.)
| | - Yakov Mamzhi
- From the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.)
| | - Christopher G Low
- California Northstate University College of Medicine, Elk Grove (C.G.L.)
| | - Alexandra C Coluzzi
- From the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.)
| | - Evan J Shih
- From the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.)
| | - Rubine Gevorgyan Fleming
- From the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.)
| | - Jeffrey L Saver
- UCLA Department of Neurology, Los Angeles, CA (J.L.S., D.S.L., A.C.)
| | | | - Andrew Charles
- UCLA Department of Neurology, Los Angeles, CA (J.L.S., D.S.L., A.C.)
| | - Jonathan M Tobis
- From the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.)
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Milev I, Zafirovska P, Zimbakov Z, Idrizi S, Ampova-Sokolov V, Gorgieva E, Ilievska L, Tosheski G, Hristov N, Georgievska-Ismail L, Anguseva T, Mitrev Z. Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience. Open Access Maced J Med Sci 2016; 4:613-618. [PMID: 28028400 PMCID: PMC5175508 DOI: 10.3889/oamjms.2016.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine. AIM Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO. MATERIAL AND METHODS Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure. RESULTS During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001). CONCLUSIONS Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms.
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Affiliation(s)
- Ivan Milev
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Planinka Zafirovska
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Zan Zimbakov
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Shpend Idrizi
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Vilma Ampova-Sokolov
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Emilija Gorgieva
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Liljana Ilievska
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Goce Tosheski
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Nikola Hristov
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Ljubica Georgievska-Ismail
- University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Tanja Anguseva
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
| | - Zan Mitrev
- Special Hospital for Surgical Diseases “Filip Vtori”, Cardiology, Skopje, Republic of Macedonia
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