Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism
Authors: Emmanuelle Le Moigne, Yannick Jobic, Serge Timsit, Clément Hoffmann, Francis Couturaud
Journal: Annals of Internal Medicine (2019)

Letters1 October 2019Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary EmbolismEmmanuelle Le Moigne, MD, PhD, Yannick Jobic, MD, PhD, Serge Timsit, MD, PhD, Clément Hoffmann, MD, and Francis Couturaud, MD, PhDEmmanuelle Le Moigne, MD, PhDBrest University Hospital, Western Brittany University, Brest, France (E.L., Y.J., S.T., C.H., F.C.)Search for more papers by this author, Yannick Jobic, MD, PhDBrest University Hospital, Western Brittany University, Brest, France (E.L., Y.J., S.T., C.H., F.C.)Search for more papers by this author, Serge Timsit, MD, PhDBrest University Hospital, Western Brittany University, Brest, France (E.L., Y.J., S.T., C.H., F.C.)Search for more papers by this author, Clément Hoffmann, MDBrest University Hospital, Western Brittany University, Brest, France (E.L., Y.J., S.T., C.H., F.C.)Search for more papers by this author, and Francis Couturaud, MD, PhDBrest University Hospital, Western Brittany University, Brest, France (E.L., Y.J., S.T., C.H., F.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0479 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Kumar and colleagues emphasize that the prevalence of PFO in our cohort (13%) was lower than expected compared with the previously reported prevalence of 20% in the general population (1). As discussed in our article and reported by others, 1 explanation may be that TTE contrast testing has low sensitivity compared with TEE, the gold standard for diagnosing PFO (2, 3). Moreover, our patients' low echogenicity (which was related to their age and comorbidities, such as emphysema) may have decreased the sensitivity of TTE. The choice to use TTE when assessing PFO was based on our scientific ...References1. Meissner I, Khandheria BK, Heit JA, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol. 2006;47:440-5. [PMID: 16412874] CrossrefMedlineGoogle Scholar2. Mahmoud AN, Elgendy IY, Agarwal N, et al. Identification and quantification of patent foramen ovale-mediated shunts: echocardiography and transcranial Doppler. Interv Cardiol Clin. 2017;6:495-504. [PMID: 28886841] doi:10.1016/j.iccl.2017.05.002 CrossrefMedlineGoogle Scholar3. Vermeer SE, Koudstaal PJ, Oudkerk M, et al. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke. 2002;33:21-5. [PMID: 11779883] CrossrefMedlineGoogle Scholar4. Katsanos AH, Psaltopoulou T, Sergentanis TN, et al. Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia: a systematic review and diagnostic test accuracy meta-analysis. Ann Neurol. 2016;79:625-35. [PMID: 26833864] doi:10.1002/ana.24609 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brest University Hospital, Western Brittany University, Brest, France (E.L., Y.J., S.T., C.H., F.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3485. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPatent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism Emmanuelle Le Moigne , Serge Timsit , Douraied Ben Salem , Romain Didier , Yannick Jobic , Nicolas Paleiron , Raphael Le Mao , Thierry Joseph , Clément Hoffmann , Angelina Dion , Jean Rousset , Grégoire Le Gal , Karine Lacut , Christophe Leroyer , Dominique Mottier , and Francis Couturaud Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism Preetham Kumar , M. Khalid Mojadidi , Bernhard Meier , and Jonathan M. Tobis Metrics Cited byAdvances in the management of cardioembolic stroke associated with patent foramen ovale 1 October 2019Volume 171, Issue 7Page: 527-528KeywordsDiagnostic imagingDisclosureEmphysemaIschemic strokePatient advocacyPulmonary embolismSpecificityStroke ePublished: 1 October 2019 Issue Published: 1 October 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...