Clinical RoPE (cRoPE) score predicts patent foramen ovale detection among stroke patients: a multicenter observational study

Giannandrea, David; Padiglioni, Chiara; Mengoni, Anna; Romoli, Michele; Galati, Franco; Vecchio, Antonio Del; Cenciarelli, Silvia; Ricci, Stefano; Consoli, Domenico

doi:10.1007/s10072-020-04386-6

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…Nevertheless, a RoPE score of 7-10 has been proposed to be more likely to reflect a pathogenic PFO, 37 and the tool has been suggested for use in predicting the presence of PFO in patients with stroke. 38 The success of recent RCTs has led to calls to codify PFO as a causative mechanism of stroke in patients with ESUS. 39 A recent consensus statement from the PFO International Workup Group proposed to update the nomenclature related to stroke risk and PFO, coining the term "PFO-associated stroke."…”

Section: Pfo and Embolic Stroke Of Undetermined Sourcementioning

confidence: 99%

“…Although clinically useful, this score does not account for characteristics of the PFO itself (discussed below) or for the presence of venous thromboembolism, which may increase the probability that a PFO is a causative lesion. Nevertheless, a RoPE score of 7-10 has been proposed to be more likely to reflect a pathogenic PFO,37 and the tool has been suggested for use in predicting the presence of PFO in patients with stroke 38…”

Section: Pfo and Embolic Stroke Of Undetermined Sourcementioning

confidence: 99%

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Advances in the management of cardioembolic stroke associated with patent foramen ovale

Grory

Ohman

Feng

et al. 2022

BMJ

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Patent foramen ovale (PFO) describes a valve in the interatrial septum that permits shunting of blood or thrombotic material between the atria. PFOs are present in approximately 25% of the healthy population and are not associated with any pathology in the vast majority of cases. However, comparisons between patients with stroke and healthy controls suggest that PFOs may be causative of stroke in certain patients whose stroke is otherwise cryptogenic. Options for the diagnosis of PFO include transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler ultrasonography. PFOs associated with an interatrial septal aneurysm seem to be more strongly linked to risk of recurrent stroke. Therapeutic options for secondary stroke prevention in the setting of a PFO include antiplatelet therapy, anticoagulation, and percutaneous device closure. Recent randomized clinical trials suggest that percutaneous closure reduces the subsequent risk of stroke in appropriately selected patients, with a large relative benefit but small absolute benefit. Referral for percutaneous PFO closure should therefore be considered in certain patients after a multidisciplinary, patient centered discussion. Areas for future study include structural biomarkers to aid in determining the role of PFO closure in older people with possible PFO associated stroke, the role of direct oral anticoagulants, and very long term outcomes after device closure.

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Section: Pfo and Embolic Stroke Of Undetermined Sourcementioning

confidence: 99%

Section: Pfo and Embolic Stroke Of Undetermined Sourcementioning

confidence: 99%

Advances in the management of cardioembolic stroke associated with patent foramen ovale

Grory

Ohman

Feng

et al. 2022

BMJ

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“…The Risk of Paradoxical Embolism (RoPE) score was the first model built for the purpose of selecting optimal patients who could benefit from occlusion therapy; however, RoPE is based on the medical history and neuroimaging findings, ignoring the morphological characteristics of PFO ( 5 ). To reduce reliance on cranial imaging, the clinical RoPE (cRoPE) score was proposed with a performance comparable to that of RoPE ( 26 ), but the latter deficiency remained. Nakayama et al ( 11 ) retrospectively evaluated the PFO characteristics in 57 patients with CS using TEE to build a high-risk PFO scoring system.…”

Section: Discussionmentioning

confidence: 99%

Change in patent foramen ovale height is associated with cryptogenic stroke and the construction of a morphology-based scoring system

Liu

Xie

Zeng

et al. 2022

Front. Cardiovasc. Med.

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IntroductionCurrent guidelines recommended patent foramen ovale (PFO) occlusion as the preferred treatment for PFO-related cryptogenic stroke (CS); however, finding the causative foramen ovale remains challenging. This study aimed to identify predictors and establish a scoring system by assessing PFO morphology and stroke-related factors.MethodsBased on a prospective multicenter registered clinical trial, we compared data mainly derived from transesophageal echocardiography (TEE) and clinical history in patients with PFO-related CS and those without CS (non-CS) with incidental PFO. Subsequently, we explored independent predictors using logistic analysis, established a scoring system based on the results, and finally evaluated the scoring system using receiver operating characteristic (ROC) analysis and internal validation.Results75 patients with PFO-related CS and 147 non-CS patients were enrolled. Multivariate logistic analysis showed that the change in PFO height, large PFO, atrial septal aneurysm (ASA), and sustained right-to-left shunt (RLS) had independent relationships with CS. Based on the odds ratio value of each independent factor, a scoring system was built: change in PFO height ≥ 1.85 mm (3 points), large PFO (2 points), ASA (5 points), sustained RLS (2 points). 0–2 points correspond to low-risk PFO, 3–5 points medium-risk PFO, and 7–12 points high-risk PFO. ROC analysis showed an area under the curve of 0.80 to predict CS. The proportion of patients with CS is increasing based on these points.ConclusionsOur study screened out the change in PFO height as an independent predictor of CS. A simple and convenient scoring system can provide constructive guidance for identifying whether the PFO is causal and consequently selecting patients more likely to benefit from closure.

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“…25 Interestingly, a large age-inclusive TCD study in another Mediterranean population found a relatively low PFO prevalence of approximately 22% both in patients with cryptogenic stroke and in patients with stroke of determined cause. 35 Furthermore, PFO prevalence in younger patients with nonCS varies widely depending on the diagnostic modality, 7 and values as low as 11% in TCD studies, 36 and as low as 7% in TEE studies have been reported. 37 The previously mentioned discrepancies may be attributed to heterogeneity among the relatively small populations of patients with stroke of known cause that have been included in different studies.…”

Section: Pfo Prevalencementioning

confidence: 99%

Prevalence of patent foramen ovale in the Greek population is high and impacts on the interpretation of the risk of paradoxical embolism (RoPE) score

Koutroulou

Tsivgoulis

Karacostas

et al. 2020

Ther Adv Neurol Disord

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Background: The risk of paradoxical embolism (RoPE) score calculates the probability that patent foramen ovale (PFO) is causally related to stroke (PFO attributable fraction, PFOAF), based on PFO prevalence in patients with cryptogenic stroke (CS) compared with that in the general population. The latter has been estimated at 25%; however, PFO prevalence in nonselected populations varies widely. Methods: Since PFO prevalence in Greece remains unknown, we evaluated it and we calculated PFOAF stratified by RoPE score in a cohort of patients with CS ⩽55 years old. PFO was detected according to the international consensus transcranial Doppler (TCD) criteria in 124 healthy subjects (H), in 102 patients with CS, and in 56 patients with stroke of known cause (nonCS). Each subject underwent unilateral middle cerebral artery recording after infusion of agitated saline, at rest, and after a controlled Valsalva maneuver. We characterized PFO as large (>20 microbubbles or curtain), moderate (11–20), and small (⩽10). Results: PFO was detected in 42.7% of H, 49% of CS, and 25% of nonCS ( p = 0.013). Large PFOs were numerically higher in CS [28.4% (29/102)] compared with H [19.3% (24/124); p = 0.1] and to nonCS [7.1% (4/56), p = 0.04]. The median RoPE score in patients with CS and PFO was seven. Even patients with very high RoPE score (9–10) had moderate PFOAF (57%). For any individual stratum up to RopE score 8, PFOAF was <33%. Conclusions: PFO prevalence in the Greek population is much higher than the widely accepted 25%. PFO may be the cause of stroke in one out of nine Greek patients with CS. Among Greek CS patients who harbor a PFO, the latter is causal in one out of five. The established RoPE score cutoff of ⩾7 for having a probable PFO-associated stroke may overestimate the probability in patients deriving from populations with high PFO prevalence.

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Clinical RoPE (cRoPE) score predicts patent foramen ovale detection among stroke patients: a multicenter observational study

Cited by 10 publications

References 24 publications

Advances in the management of cardioembolic stroke associated with patent foramen ovale

Advances in the management of cardioembolic stroke associated with patent foramen ovale

Change in patent foramen ovale height is associated with cryptogenic stroke and the construction of a morphology-based scoring system

Prevalence of patent foramen ovale in the Greek population is high and impacts on the interpretation of the risk of paradoxical embolism (RoPE) score

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