Severity by National Institute of Health Stroke Scale Score and Clinical Features of Stroke Patients with Patent Foramen Ovale Stroke and Atrial Fibrillation

Kaito Abe; Fumiya Hasegawa; Ryota Nakajima; Hidetoshi Fukui; Moto Shimada; Takahiro Miyazaki; Hiroshi Doi; Goro Endo; Kaori Kanbara; Yasuyuki Mochida; Jun Okuda; Nobuya Maeda; Akira Isoshima; Koichi Tamura; Tomoaki Ishigami

doi:10.3390/jcm10020332

Severity by National Institute of Health Stroke Scale Score and Clinical Features of Stroke Patients with Patent Foramen Ovale Stroke and Atrial Fibrillation

J Clin Med. 2021 Jan 18;10(2):332. doi: 10.3390/jcm10020332.

Authors

Kaito Abe^{1

2}, Fumiya Hasegawa^{1

2}, Ryota Nakajima¹, Hidetoshi Fukui¹, Moto Shimada^{1

2}, Takahiro Miyazaki^{1

2}, Hiroshi Doi^{1

2}, Goro Endo¹, Kaori Kanbara^{1

2}, Yasuyuki Mochida^{1

2}, Jun Okuda^{1

2}, Nobuya Maeda³, Akira Isoshima⁴, Koichi Tamura², Tomoaki Ishigami²

Affiliations

¹ Department of Cardiology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-Ward, Tokyo 143-8527, Japan.
² Department of Medical Science and Cardiorenal Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-Ward, Yokohama City 236-0004, Japan.
³ Department of Neurology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-Ward, Tokyo 143-8527, Japan.
⁴ Department of Neurosurgery, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-Ward, Tokyo 143-8527, Japan.

Abstract

The comparative severity of patent foramen ovale (PFO)-related stroke in patients without atrial fibrillation (AF) and AF-related stroke in patients without PFO is unknown. Therefore, we compared the severity of PFO-related stroke and AF-related stroke. Twenty-six patients who underwent transesophageal echocardiography (TEE) were diagnosed with cardioembolic stroke from July 2018 to March 2020. Cases with AF detected by electrocardiograms or thrombus in the left atrium or left atrial appendage on TEE were included in the AF-related stroke group. Cases with a positive microbubble test on the Valsalva maneuver during TEE, and with no other factors that could cause stroke, were included in the PFO-related stroke group. This study was designed as a single-center, small population pilot study. The stroke severity of the two groups by the National Institute of Health Stroke Scale (NIHSS) score was compared by statistical analysis. Of the 26 cases, five PFO-related stroke patients and 21 AF-related stroke patients were analyzed. The NIHSS score was 2.2 ± 2.8 and 11.5 ± 9.2 (p-value < 0.01), the rate of hypertension was 20.0% and 85.7% (p-value = 0.01), and the HbA1c value was 5.5 ± 0.2% and 6.3 ± 1.3% (p-value = 0.02) in the PFO-related and AF-related stroke groups, respectively. Compared with AF-related stroke patients, stroke severity was low in PFO-related stroke patients.

Keywords: National Institute of Health Stroke Scale score; atrial fibrillation and stroke; cryptogenic stroke; patent foramen ovale and stroke; severity of stroke.