Circulation: Cardiovascular Imaging HCI Transesophageal Echocardiography in Cryptogenic Stroke and PFO: The Analysis of Putative High Risk Features from the Risk of Paradoxical Embolism (RoPE) Database Wessler et al: TEE High Risk Features: PFO in Cryptogenic Stroke CIRCCVIM/2013/000807 CIRCCVIM/2013/000807 10.1161/CIRCIMAGING.113.000807 7 01/21/14 1 Picillo Emily 617-542-5100 617-542-6539 Davidoff, Ravin Boston Medical Center Dr. David M Kent dkent1@tuftsmedicalcenter.org Dr. Tufts Medical Center 800 Washington St, Box #63 Boston Massachusetts 02111 UNITED STATES 617-6363234 1-617-6368023 44231 Benjamin Wessler Tufts Medical Center bwessler@tuftsmedicalcenter.org 144420 David E. Thaler Tufts Medical Center dthaler@tuftsmedicalcenter.org 17401 Robin Ruthazer Tufts Medical Center rruthazer@tuftsmedicalcenter.org 136995 Christian Weimar University of Duisburg - Essen stroke.med@uni-essen.de 44366 Marco R Di Tullio Columbia University Medical Center md42@columbia.edu 113567 Mitchell S. Elkind Columbia University mse13@columbia.edu 10001 Shunichi Homma Columbia University Medical Center sh23@columbia.edu 16792 Jennifer Lutz Tufts Medical Center jlutz@tuftsmedicalcenter.org 144426 Jean-Louis Mas Hopital Sainte-Anne jl.mas@ch-sainte-anne.fr 22606 Heinrich P Mattle University Hospital, Berne heinrich.mattle@bluewin.ch 93706 Bernhard Meier Swiss Cardiovascular Center bernhard.meier@insel.ch 10536 Krassen Nedeltchev Cantonal Hospital Aarau krassen.nedeltchev@ksa.ch 156251 Federica Papetti "Sapienza"University of Rome fpfedericapapetti@gmail.com 50120 Emanuele Di Angelantonio University of Cambridge ed303@medschl.cam.ac.uk 55582 Mark Reisman -Swedish Medical Center mark.reisman@swedish.org 65832 Joaquín Serena Hospital Universitari Dr. Josep Trueta jserena.girona.ics@gencat.cat 44549 David M Kent Tufts Medical Center dkent1@tuftsmedicalcenter.org 44231 06/17/2013 06/17/2013 10/16/2013 10/22/2013 11/08/2013 01/21/2014 Original Articles CIRCCVIM/2013/001361 Editorial on "Transesophageal Echocardiography in Cryptogenic Stroke and PFO: The Analysis of Putative High Risk Features from the Risk of Paradoxical Embolism (RoPE) Database" (Please provide an original title upon submission) <p><b><i>Background</i></b>—Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS), though the pathogenicity of a discovered PFO in the setting of CS is typically unclear. Transesophageal echocardiography (TEE) features such as PFO size, an associated hypermobile septum, and presence of a right-to-left shunt at rest have all been proposed as markers of risk. The association of these TEE features with other markers of pathogenicity has not been examined. </p><p><b><i>Methods and Results</i></b>—We used a recently derived score based on clinical and neuroimaging features to stratify patients with PFO and CS by the probability that their stroke is PFO-attributable. We examined whether high risk TEE features are seen more frequently in patients more likely to have had a PFO-attributable stroke (n = 637) compared to those less likely to have a PFO attributable stroke (n = 657). Large physiologic shunt size was not more frequently seen among those with probable PFO-attributable strokes (OR=0.92; p = 0.53). Neither the presence of a hypermobile septum nor a right-to-left shunt at rest were detected more often in those with a probable PFO-attributable stroke (OR=0.80; p = 0.45 and OR=1.15; 0.11 respectively). </p><p><b><i>Conclusions</i></b>—We found no evidence that the proposed TEE risk markers of large PFO size, hypermobile septum, and presence of right-to-left shunt at rest are associated with clinical features suggesting that a CS is PFO-attributable. Additional tools to describe PFOs may be useful in helping to determine whether an observed PFO is incidental or pathogenically related to CS.</p> 3 0 1 0 1 no yes CIRCCVIM_CIRCCVIM-2013-000807.xml CIRCCVIM_CIRCCVIM-2013-000807_file1.doc

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CIRCCVIM_CIRCCVIM-2013-000807_supp1.doc CIRCCVIM_CIRCCVIM-2013-000807_supp2.pdf CIRCCVIM_CIRCCVIM-2013-000807_merge.pdf CIRCCVIM_CIRCCVIM-2013-000807_Kent_44231_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Kent_44231_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Lutz_144426_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Lutz_144426_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Wessler_144420_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Wessler_144420_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Weimar_44366_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Weimar_44366_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Ruthazer_136995_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Ruthazer_136995_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Homma_16792_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Homma_16792_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Meier_10536_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Meier_10536_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Nedeltchev_156251_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Nedeltchev_156251_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Mattle_93706_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Mattle_93706_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Di_Tullio_113567_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Di_Tullio_113567_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Thaler_17401_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Thaler_17401_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Serena_44549_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Serena_44549_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Elkind_10001_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Elkind_10001_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Reisman_65832_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Reisman_65832_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Mas_22606_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Mas_22606_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Papetti_50120_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Papetti_50120_copyright.pdf CIRCCVIM_CIRCCVIM-2013-000807_Di_Angelantonio_55582_disclosure.pdf CIRCCVIM_CIRCCVIM-2013-000807_Di_Angelantonio_55582_copyright.pdf Please charge authors $70 per page MS has clinical perspective and supplemental PDF Please set the flag 'exportcadmusahafundingtypecodes' with the funding type code of the sources you wish to list. Subject Codes: [41] Pediatric and congenital heart disease, including cardiovascular surgery [124] Cardiovascular imaging agents/techniques [31] Echocardiography [13] Cerebrovascular disease/stroke [66] Risk factors for stroke epicillo