Document Detail

Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism.
MedLine Citation:
PMID:  9609088     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Right-to-left shunt through a patent foramen ovale is frequently diagnosed by contrast echocardiography and can be particularly prominent in the presence of elevated pressures in the right side of the heart. Its prognostic significance in patients with pulmonary thromboembolism, however, is unknown. METHODS AND RESULTS: The present prospective study included 139 consecutive patients with major pulmonary embolism diagnosed on the basis of clinical, echocardiographic, and cardiac catheterization criteria. All patients underwent contrast echocardiography at presentation. The end points of the study were overall mortality and complicated clinical course during the hospital stay defined as death, cerebral or peripheral arterial thromboembolism, major bleeding, or need for endotracheal intubation or cardiopulmonary resuscitation. Patent foramen ovale was diagnosed in 48 patients (35%). These patients had a death rate of 33% as opposed to 14% in patients with a negative echo-contrast examination (P=.015). Logistic regression analysis demonstrated that the only independent predictors of mortality in the study population were a patent foramen ovale (odds ratio [OR], 11.4; P<.001) and arterial hypotension at presentation (OR, 26.3; P<.001). Patients with a patent foramen ovale also had a significantly higher incidence of ischemic stroke (13% versus 2.2%; P=.02) and peripheral arterial embolism (15 versus 0%; P<.001). Overall, the risk of a complicated in-hospital course was 5.2 times higher in this patient group (P<.001). CONCLUSIONS: In patients with major pulmonary embolism, echocardiographic detection of a patent foramen ovale signifies a particularly high risk of death and arterial thromboembolic complications.
S Konstantinides; A Geibel; W Kasper; M Olschewski; L Blümel; H Just
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  97     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-06-18     Completed Date:  1998-06-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1946-51     Citation Subset:  AIM; IM    
Abteilung Innere Medizin III-Kardiologie, Universitaetsklinik Freiburg, Germany.
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MeSH Terms
Aged, 80 and over
Cerebrovascular Disorders / epidemiology*
Diagnosis, Differential
Echocardiography, Doppler
Heart Catheterization
Heart Septal Defects / complications*,  mortality,  ultrasonography
Heart Septum / ultrasonography*
Hypertension, Pulmonary / complications,  diagnosis
Intracranial Embolism and Thrombosis / epidemiology
Middle Aged
Predictive Value of Tests
Pulmonary Embolism / diagnosis*,  mortality,  physiopathology
Risk Factors
Survival Analysis
Thromboembolism / epidemiology
Comment In:
Circulation. 1999 Jun 29;99(25):3323   [PMID:  10385511 ]

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