EACVI survey on the management of patients with patent foramen ovale and cryptogenic stroke

Eur Heart J Cardiovasc Imaging. 2021 Jan 22;22(2):135-141. doi: 10.1093/ehjci/jeaa318.


Aims: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate the current practice for the assessment and management of patients with suspected patent foramen ovale (PFO) and cryptogenic stroke.

Methods and results: In total, 79 imaging centres from 34 countries across the world responded to the survey, which comprised 17 questions. Most non-invasive investigations for PFO were widely available in the responding centres, with the exception of transcranial colour Doppler which was only available in 70% of sites, and most commonly performed by neurologists. Standard transthoracic echocardiography, with or without bubbles, was considered the first-level test for suspected PFO in the majority of the centres, whereas transoesophageal echocardiography was an excellent second-level modality. Most centres would rule out atrial fibrillation (AF) as a source of embolism in all patients with cryptogenic stroke (63%), with the remainder reserving investigation for patients with multiple AF risk factors (33%). Cardiac magnetic resonance was the preferred tool for identifying other unusual aetiologies, like cardiac masses or thrombi. After PFO closure, there was variation in the use of antiplatelet therapy: a quarter recommended treatment for life, while only 12% recommended 5 years as stipulated in the guidelines (12%). Antibiotic prophylaxis prior to dental or endoscopic procedures was not recommended in 41% of centres, contrary to what the guidelines recommended.

Conclusion: Our survey revealed a variable adherence to the current recommendations for the diagnosis and management of patients with cryptogenic stroke and PFO. Efforts should focus on optimizing and standardizing diagnostic tests and treatment of this condition.

Keywords: cryptogenic stroke; patent foramen ovale; transoesophageal echocardiography/transcranial Doppler/survey/EACVI.

MeSH terms

  • Atrial Fibrillation*
  • Foramen Ovale, Patent* / complications
  • Foramen Ovale, Patent* / diagnostic imaging
  • Foramen Ovale, Patent* / epidemiology
  • Humans
  • Ischemic Stroke*
  • Risk Factors
  • Stroke* / diagnostic imaging
  • Stroke* / epidemiology
  • Stroke* / etiology