Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study
Background A patent foramen ovale (PFO) with atrial septal aneurysm (ASA) has been identified as a risk factor for cryptogenic stroke. Patients with migraine with aura (MA) appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association bet...
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| Format: | Article |
| Language: | English |
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Wiley
2016-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.003771 |
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| author | Roel J. R. Snijder Justin G. L. M. Luermans Albert H. de Heij Vincent Thijs Wouter J. Schonewille Alexander Van De Bruaene Martin J. Swaans Werner I. H. L. Budts Martijn C. Post |
| author_facet | Roel J. R. Snijder Justin G. L. M. Luermans Albert H. de Heij Vincent Thijs Wouter J. Schonewille Alexander Van De Bruaene Martin J. Swaans Werner I. H. L. Budts Martijn C. Post |
| author_sort | Roel J. R. Snijder |
| collection | DOAJ |
| description | Background A patent foramen ovale (PFO) with atrial septal aneurysm (ASA) has been identified as a risk factor for cryptogenic stroke. Patients with migraine with aura (MA) appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between MA and PFO with ASA has never been reported. We examined this association in a large observational study. Methods and Results Patients (>18 years) who underwent an agitated saline transesophageal echocardiography (cTEE) at our outpatient clinics within a timeframe of 4 years were eligible to be included. Before cTEE they received a validated headache questionnaire. Two neurologists diagnosed migraine with or without aura according to the International Headache Criteria. A total of 889 patients (mean age 56.4±14.3 years, 41.7% women) were included. A PFO was present in 23.2%, an isolated ASA in 2.7%, and a PFO with ASA in 6.9%. The occurrence of migraine was 18.9%; the occurrence of MA was 8.1%. The prevalence of PFO with ASA was significantly higher in patients with MA compared to patients without migraine (18.1% vs 6.1%; OR 3.72, 95% CI 1.86‐7.44, P<0.001). However, a PFO without ASA was not significantly associated with MA (OR 1.50, 95% CI 0.79‐2.82, P=0.21). Interestingly, a PFO with ASA was strongly associated with MA (OR 2.71, 95% CI 1.23‐5.95, P=0.01). Conclusion In this large observational study, PFO with ASA was significantly associated with MA only. PFO closure studies should focus on this specific intra‐atrial anomaly. |
| format | Article |
| id | doaj-art-538e4ba1a1be449ab2e87e580101f6a6 |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2016-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-538e4ba1a1be449ab2e87e580101f6a62025-08-20T03:16:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-12-0151210.1161/JAHA.116.003771Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational StudyRoel J. R. Snijder0Justin G. L. M. Luermans1Albert H. de Heij2Vincent Thijs3Wouter J. Schonewille4Alexander Van De Bruaene5Martin J. Swaans6Werner I. H. L. Budts7Martijn C. Post8Department of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology Maastricht University Medical Centre Maastricht The NetherlandsDepartment of Internal Medicine Medical Centre Leeuwarden Leeuwarden The NetherlandsFlorey Institute of Neuroscience and Mental Health University of Melbourne Victoria AustraliaDepartment of Neurology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology University Health Network Toronto CanadaDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsDepartment of Cardiology University Hospital Gasthuisberg Leuven BelgiumDepartment of Cardiology St. Antonius Hospital Nieuwegein The NetherlandsBackground A patent foramen ovale (PFO) with atrial septal aneurysm (ASA) has been identified as a risk factor for cryptogenic stroke. Patients with migraine with aura (MA) appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between MA and PFO with ASA has never been reported. We examined this association in a large observational study. Methods and Results Patients (>18 years) who underwent an agitated saline transesophageal echocardiography (cTEE) at our outpatient clinics within a timeframe of 4 years were eligible to be included. Before cTEE they received a validated headache questionnaire. Two neurologists diagnosed migraine with or without aura according to the International Headache Criteria. A total of 889 patients (mean age 56.4±14.3 years, 41.7% women) were included. A PFO was present in 23.2%, an isolated ASA in 2.7%, and a PFO with ASA in 6.9%. The occurrence of migraine was 18.9%; the occurrence of MA was 8.1%. The prevalence of PFO with ASA was significantly higher in patients with MA compared to patients without migraine (18.1% vs 6.1%; OR 3.72, 95% CI 1.86‐7.44, P<0.001). However, a PFO without ASA was not significantly associated with MA (OR 1.50, 95% CI 0.79‐2.82, P=0.21). Interestingly, a PFO with ASA was strongly associated with MA (OR 2.71, 95% CI 1.23‐5.95, P=0.01). Conclusion In this large observational study, PFO with ASA was significantly associated with MA only. PFO closure studies should focus on this specific intra‐atrial anomaly.https://www.ahajournals.org/doi/10.1161/JAHA.116.003771atrial septal aneurysmcerebrovascular disordersechocardiographyheart septal defectmigrainepatent foramen ovale |
| spellingShingle | Roel J. R. Snijder Justin G. L. M. Luermans Albert H. de Heij Vincent Thijs Wouter J. Schonewille Alexander Van De Bruaene Martin J. Swaans Werner I. H. L. Budts Martijn C. Post Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial septal aneurysm cerebrovascular disorders echocardiography heart septal defect migraine patent foramen ovale |
| title | Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study |
| title_full | Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study |
| title_fullStr | Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study |
| title_full_unstemmed | Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study |
| title_short | Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study |
| title_sort | patent foramen ovale with atrial septal aneurysm is strongly associated with migraine with aura a large observational study |
| topic | atrial septal aneurysm cerebrovascular disorders echocardiography heart septal defect migraine patent foramen ovale |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.003771 |
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