Comparative analysis of echocardiographic and clinical
characteristics among patients afflicted by embolic stroke of
undetermined source and migraine, both accompanied by patent foramen
ovale
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.
Keywords: Patent foramen ovale (PFO), migraine, embolic stroke
of undetermined source (ESUS), transthoracic echocardiography